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
. 2025 Oct;26(10):1619-1625.
doi: 10.1111/hiv.70085. Epub 2025 Jul 30.

Blood pressure and metabolic outcomes after efavirenz- or dolutegravir-based therapy started in acute HIV infection

Phillip Chan  1   2 , Sarah Moreland  3   4 , Carlo Sacdalan  5   6 , Donn J Colby  3   4 , Ferron Ocampo  5 , Pathariya Promsena  5 , Somchai Sriplienchan  5 , Jarawee Wattana  5 , Jintana Intasan  5 , Nittaya Phanuphak  7 , Sandhya Vasan  3   4 , Robert Paul  8 , Lydie Trautmann  3   4 , Serena Spudich  1   2 , Eugène Kroon  5   7 ; RV254/SEARCH 010 Study Team
Affiliations

Blood pressure and metabolic outcomes after efavirenz- or dolutegravir-based therapy started in acute HIV infection

Phillip Chan et al. HIV Med. 2025 Oct.

Abstract

Objective: This retrospective study compared changes in body mass index (BMI), systolic and diastolic blood pressure (SBP and DBP) and lipid profile at 96 weeks following initiation of efavirenz/tenofovir disoproxil fumarate/emtricitabine (EFV/TDF/FTC) or dolutegravir/abacavir/lamivudine (DTG/ABC/3TC), two frequently used antiretroviral therapy (ART) regimens in prior and current World Health Organization (WHO) ART guidelines during acute HIV infection (AHI).

Methods: Participants included 304 Thai RV254 AHI cohort participants (mean age 28, 98% male); 160 (53%) initiated EFV/TDF/FTC and 144 (47%) DTG/ABC/3TC during AHI. All maintained their ART regimens for 96 weeks, with assessments at weeks 0, 24, 48, 72 and 96. Longitudinal changes were compared using linear mixed models.

Results: At week 0, the two groups were similar in age, sex, levels of plasma HIV RNA, CD4+ and CD8+ T-cell counts and CD4/CD8 ratios, along with levels of total cholesterol (TC), low-density lipoprotein (LDL) and DBP. However, DTG/ABC/3TC users had higher BMI and lower SBP than EFV/TDF/FTC users (p < 0.05). After 96 weeks, DTG/ABC/3TC users demonstrated greater increases in BMI, SBP, TC and LDL than EFV/TDF/FTC users in unadjusted and adjusted models corrected for age, sex and Fiebig staging (p < 0.05), while their changes in DBP and high-density lipoprotein did not differ.

Conclusions: In these young men initiating ART during AHI, DTG/ABC/3TC users exhibited greater increases in BMI, SBP, TC and LDL than EFV/TDF/FTC users by week 96. In addition to body weight changes, clinicians should remain vigilant regarding blood pressure and cholesterol changes following ART initiation, especially in those with pre-existing cardiovascular risk factors.

Keywords: RV254; acute HIV infection; antiretroviral therapy; blood cholesterol; blood pressure; body weight.

PubMed Disclaimer

References

REFERENCES

    1. Feeney ER, Mallon PW. HIV and HAART‐associated dyslipidemia. Open Cardiovasc Med J. 2011;5:49‐63.
    1. Kanters S, Renaud F, Rangaraj A, et al. Evidence synthesis evaluating body weight gain among people treating HIV with antiretroviral therapy – a systematic literature review and network meta‐analysis. EClinicalMedicine. 2022;48:101412.
    1. Brennan AT, Nattey C, Kileel EM, et al. Change in body weight and risk of hypertension after switching from efavirenz to dolutegravir in adults living with HIV: evidence from routine care in Johannesburg, South Africa. EClinicalMedicine. 2023;57:101836.
    1. Sax PE, Erlandson KM, Lake JE, et al. Weight gain following initiation of antiretroviral therapy: risk factors in randomized comparative clinical trials. Clin Infect Dis. 2020;71:1379‐1389.
    1. Chandiwana NC, Siedner MJ, Marconi VC, et al. Weight gain after HIV therapy initiation: pathophysiology and implications. J Clin Endocrinol Metab. 2024;109:e478‐e487.

MeSH terms