Weight Gain Among Treatment-Naïve Persons With HIV Receiving Dolutegravir in Kenya

Abstract

Background: Several recent studies have linked integrase strand transfer inhibitors (INSTI) with increased weight gain.

Setting: The effects of sex on weight gain with dolutegravir (DTG)-based antiretroviral therapy (ART) among treatment-naïve participants in a lower-income, sub-Saharan population with high rates of pre-ART underweight and tuberculosis (TB) coinfection are unknown.

Methods: Our analysis included treatment-naïve participants in Kenya and starting their first treatment regimen between January 1, 2015, and September 30, 2018. Participants were grouped into 2 cohorts based on the initial treatment regimen [DTG vs. nonnucleoside reverse transcriptase inhibitors (NNRTI)]. We modelled weight changes over time using a multivariable nonlinear mixed-effect model, with participant as a random effect. Logistic regression models were constructed to evaluate the association between different variables with extreme increase in body mass index (≥10% increase).

Results: Seventeen thousand forty-four participants met our inclusion criteria. Sixty-two percent of participants were women, 6% were receiving active TB therapy, and 97% were on NNRTI-based regimens. Participants starting DTG-based regimens were more likely to gain weight when compared with participants starting NNRTI-based regimens. Female participants starting DTG-based regimens experienced the highest weight gain compared with other participants (mean gain of 6.1 kgs at 18 months). Female participants receiving DTG-based regimens, along with participants with lower CD4 cell counts, underweight at baseline, and those receiving active TB therapy were also at higher risk for extreme body mass index increase.

Conclusions: Our study in a lower-income sub-Saharan African population confirms higher weight gain with DTG-based regimens compared with traditional ART for treatment-naïve patients.

Figure 1.

Changes in weight over time by sex and treatment regimen. NNRTI: Non-nucleoside reverse-transcriptase inhibitor; DTG: Dolutegravir.

Figure 2.

Projected weight gain by sex and treatment regimen at 6-, 12- and 18-months. NNRTI: Non-nucleoside reverse-transcriptase inhibitor; DTG: Dolutegravir. (NNRTI Male = dashed black column, NNRTI Female = solid black column, DTG Male = dashed gray column, DTG Female = solid gray column).

Figure 3.

Difference in weight gain among participants starting antiretroviral therapy by tuberculosis coinfection status. Weight estimates standardized for female participants, ages 29 – 45, starting NNRTI-based therapy. (A): Starting weight, (B): Ending weight, and (C): Weight gain by TB co-infection status. TB: Tuberculosis.

Figure 4.

Adjusted hazard of extreme weight gain, defined as more than 10% increase in BMI compared to baseline, among participants starting ART. NNRTI, Non-nucleoside reverse-transcriptase inhibitor; DTG, Dolutegravir; BMI, Body Mass Index.