Dolutegravir ARV Drug Linked To Spike In Obesity and Hypertension In Zimbabwe’s People Living With HIV-New Study

By Michael Gwarisa

Significant weight gain and a high incidence of Hypertension cases have been picked among Zimbabweans Living with HIV who switched to Dolutegravir (DTG), based, efavirenz (EFV)-based and ritonavir-boosted atazanavir (ATV/r)-based Antiretroviral Therapy (ART) in Zimbabwe.

A longitudinal study conducted by Zimbabwe’s renowned Clinical Scientist and Laboratory expert, Tinei Shmu et al which sought to explore  “Body weight and blood pressure changes on dolutegravir-, efavirenz- or atazanavir-based antiretroviral therapy in Zimbabwe” gathered that the Zimbabwe’s HIV response now faces an increased burden of Non-Communicable Diseases (NCDs).

The study analysed 99,969 weight and 35,449 blood pressure records from 9487 adults (DTG: 4593; EFV: 3599; ATV/r: 1295). At 24 months after starting or switching to DTG, estimated median weight gains were 4.54 kg (90% credibility interval 3.88−5.28 kg) in women and 3.71 kg (3.07−4.45 kg) in men, around twice that observed for ATV/r and over four-times the gain observed for EFV.

Prevalence of high blood pressure among PLHIV receiving DTG-based ART increased from around 5% at baseline to over 20% at 24 months, with no change in PLHIV receiving EFV- or ATV/r-based ART,” reads part of the study.

The study also noted that high blood pressure in PLHIV switching to DTG was associated with weight gain, with stronger increases in the proportion with high blood pressure for larger weight gains.

The researchers compared weight and blood pressure trends and examined the association between high blood pressure and weight gain among people living with HIV (PLHIV) switching to or starting DTG-based, efavirenz (EFV)-based and ritonavir-boosted atazanavir (ATV/r)-based ART in Zimbabwe.

The study also selected PLHIV aged 18 years or older who started or switched to DTG, EFV or ATV/r-based ART between January 2004 and June 2022 at Newlands Clinic in Harare, Zimbabwe, were eligible.

“Weight was measured at all visits (Seca floor scales); blood pressure only at clinician-led visits (Omron M2 sphygmomanometer). We used Bayesian additive models to estimate trends in weight gain and the proportion with high blood pressure (systolic >140 mmHg or diastolic >90 mmHg) in the first 2 years after starting or switching the regimen.”

Finally, the study examined whether trends in the proportion with high blood pressure were related to weight change.

“Among PLHIV starting ART or switching to a new regimen, DTG-based ART was associated with larger weight gains and a substantial increase in the prevalence of high blood pressure.  Routine weight and blood pressure measurement and interventions to lower blood pressure could benefit PLHIV on DTG-based ART. Further studies are needed to elucidate the mechanisms and reversibility of these changes after discontinuation of DTG,” added the study.

Meanwhile, several studies have also found an association between INSTI-based ART and weight gain. DTG was associated with greater weight gain than other antiretroviral classes and older INSTIs like raltegravir . Among PLHIV newly initiating ART or switching regimens following treatment failure, weight gain can be expected as part of the desired return-to-health phenomenon .

However, among PLHIV transitioning from successful non-DTG-based ART to DTG for programmatic reasons, weight gain is an undesired effect that could herald an increasing cardiometabolic disease risk, including associated hypertension and chronic kidney disease. Older cohort studies in the United States and Europe demonstrated the precedence of obesity before hypertension.

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