Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug 2;73(3):e580-e586.
doi: 10.1093/cid/ciaa1652.

Transition to Dolutegravir Is Associated With an Increase in the Rate of Body Mass Index Change in a Cohort of Virally Suppressed Adolescents

Neil Thivalapill  1 , Tandzile Simelane  2 , Nobuhle Mthethwa  3 , Sandile Dlamini  2 , Bhekumusa Lukhele  2   4   5 , Velephi Okello  6 , H Lester Kirchner  4   5   7 , Anna M Mandalakas  4   5 , Alexander W Kay  2   4   5
Affiliations

Transition to Dolutegravir Is Associated With an Increase in the Rate of Body Mass Index Change in a Cohort of Virally Suppressed Adolescents

Neil Thivalapill et al. Clin Infect Dis. .

Abstract

Background: Antiretroviral therapy (ART) regimens that contain dolutegravir (DTG) have been associated with increases in body mass index (BMI) in adults. However, this relationship has not been well described in adolescents.

Methods: In a retrospective observational cohort of 460 virally suppressed (<200 copies/mL) adolescents living with human immunodeficiency virus at a clinical site in Eswatini, body mass index (BMI) measurements were analyzed between 1 year prior to the transition to DTG and up to 1 year after DTG transition. Random-effects linear spline models were used to describe the rate of change in BMI before and after the transition to DTG.

Results: In adolescents, BMI increased at a rate of 0.3 kg/m2 per year before DTG transition and increased to a rate of 1.2 kg/m2 per year after DTG transition. Sex of the adolescent modified the relationship between DTG and rate of BMI change: BMI rate of change after DTG transition was increased by 1.1 kg/m2 in females and 0.6 kg/m2 per year in males.

Conclusions: Transition to DTG in virally suppressed adolescents (aged 10-19 years) is associated with an increase in the rate of BMI change. Female adolescents may experience a larger change than males. Further investigation is required to elucidate the mechanism that underlies these observations and to assess how DTG impacts BMI in adolescents following longer durations of treatment.

Keywords: HIV; adolescent; adverse events; body mass index.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Flowchart of patients included in the sample. Abbreviations: ARV, antiretroviral; DTG, dolutegravir; VL, viral load.
Figure 2.
Figure 2.
Dolutegravir (DTG) is associated with an acceleration in body mass index (BMI) increase. Predictions were constructed using the following covariate values: male, 14 years old at DTG transition, previously on nevirapine-based antiretroviral therapy, and transitioned to tenofovir disoproxil fumarate/lamivudine/DTG. Predicted BMI and 95% predictive intervals (PIs) were constructed using estimates and the associated standard error of prediction from the fully adjusted model fitted in those who were thin, normal weight, or obese/overweight prior to DTG transition.
Figure 3.
Figure 3.
Dolutegravir (DTG) is associated with a greater acceleration in body mass index (BMI) increase among females compared with males. Predictions were constructed using the following covariate values: 14 years old at DTG transition, previously on nevirapine-based antiretroviral therapy, and transitioned to tenofovir disoproxil fumarate/lamivudine/DTG. Predicted BMI and 95% predictive intervals (PIs) were constructed using estimates and the associated standard error of prediction from the fully adjusted model fitted in either male or female adolescents.
Figure 4.
Figure 4.
Dolutegravir (DTG) transition is associated with changes in body mass index-for-age z score (BAZ), weight-for age z score (WAZ), and height-for-age z score (HAZ). Predictions were constructed using the following covariate values: male, 14 years old at DTG transition, previously on nevirapine-based antiretroviral therapy, and transitioned to tenofovir disoproxil fumarate/lamivudine/DTG. Predicted BAZ, WAZ, and HAZ and 95% predictive intervals (PIs) were constructed using estimates and the associated standard error of prediction from the fully adjusted models fitted in the whole cohort.
See this image and copyright information in PMC

References

    1. Mark D, Armstrong A, Andrade C, . et al. HIV treatment and care services for adolescents: a situational analysis of 218 facilities in 23 sub-Saharan African countries. J Int AIDS Soc 2017; 20:21591. - PMC - PubMed
    1. Van de Wijer L, Mchaile DN, de Mast Q, . et al. Neuropsychiatric symptoms in Tanzanian HIV-infected children receiving long-term efavirenz treatment: a multicentre, cross-sectional, observational study. Lancet HIV 2019; 6:e250–8. - PubMed
    1. Kanters S, Vitoria M, Doherty M, . et al. Comparative efficacy and safety of first-line antiretroviral therapy for the treatment of HIV infection: a systematic review and network meta-analysis. Lancet HIV 2016; 3:e510–20. - PubMed
    1. Venter WDF, Moorhouse M, Sokhela S, . et al. Dolutegravir plus two different prodrugs of tenofovir to treat HIV. N Engl J Med 2019; 381:803–15. - PubMed
    1. World Health Organization. Update of recommendations on first- and second-line antiretroviral regimens.2019. Available at: https://apps.who.int/iris/bitstream/handle/10665/325892/WHO-CDS-HIV-19.1.... Accessed 10 August 2020.

Publication types