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Observational Study
. 2025 Mar 15;39(4):362-372.
doi: 10.1097/QAD.0000000000004085. Epub 2024 Dec 5.

Body weight changes in people with HIV starting dolutegravir versus efavirenz-based regimens in a large cohort in rural Tanzania

Maja Weisser  1   2   3   4 , Herry Mapesi  1   2   3 , Fiona Vanobberghen  2   3 , James Okuma  2   3 , Anna Eichenberger  2   3   5 , Herieth Ismael Wilson  1   6 , Daniel Henry Paris  2   3 , Aneth Vedastus Kalinjuma  1   7 , Ezekiel Luoga  2   3 , Lulu Wilson  1 , Tracy Renée Glass  2   3 , Fabian Christoph Franzeck  3   8   9 ; KIULARCO Study Group
Affiliations
Observational Study

Body weight changes in people with HIV starting dolutegravir versus efavirenz-based regimens in a large cohort in rural Tanzania

Maja Weisser et al. AIDS. .

Abstract

Objectives: To analyze weight changes associated with dolutegravir- versus efavirenz-based antiretroviral therapy (ART) in people with HIV (PWH) in rural Tanzania, where undernutrition is prevalent.

Design: Longitudinal, observational study of the prospective Kilombero and Ulanga Antiretroviral Cohort (KIULARCO).

Methods: We included adult, ART-naïve, nonpregnant PWH initiating efavirenz-based ART 12/2016-02/2019 or dolutegravir-based ART 03/2019-12/2022. We used multivariable linear mixed-effects models to assess adjusted weight changes during 18 months after ART start and Cox regression models to assess factors associated with incident obesity, weight gain ≥10% and hypertension.

Results: Of 1205 PWH at ART start [median age 40 years (interquartile range (IQR) 32-48); 719 (59.7%) females], 166 (13.8%) individuals were underweight and 317 (26.3%) overweight/obese; 621 (51.5%) initiated efavirenz-based and 584 (48.5%) dolutegravir-based ART. After 18 months, estimated weight gain was 5.1 kg [95% confidence interval (CI) 4.7-5.5] in the dolutegravir versus 4.0 kg (95% CI 3.7-4.4) in the efavirenz group. The weight gain difference between treatment groups was high in men (1.7 kg (95% CI 0.8-2.6; P < 0.001)), in those aged 30-49 years (1.5 kg (0.8-2.1); P < 0.001) and those with CD4 + cell count ≥500/ul (2.5 kg (1.4-3.7), P < 0.001)). Cumulative obesity incidence at 18 months was 10.9% (95% CI 8.3-14.0) in the dolutegravir and 5.1% (95% CI 3.6-7.1) in the efavirenz group. Associated factors were dolutegravir and a pre-ART body mass index (BMI) of 25-29 kg/m 2 . Dolutegravir and age, but not weight gain were associated with incident of hypertension.

Conclusions: Dolutegravir-based ART was associated with more weight gain, higher obesity and hypertension - especially in those with a higher pre-ART BMI compared to efavirenz-based regimens.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Fig. 1
Fig. 1
CONSORT diagram of patient inclusion and exclusion.
Fig. 2
Fig. 2
(a–d) Model-estimated weight change (a) and absolute weight trajectories by sex (b), by CD4+ cells (c) and WHO stages (d) in participants starting on dolutegravir or efavirenz.
Fig. 3
Fig. 3
Cox proportional hazard models for the outcomes of (a) weight gain >10% and (b) incident obesity.
See this image and copyright information in PMC

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