Unlocking the Potential: Exploring the Impact of Dolutegravir Treatment on Body Mass Index Improvement in Underweight Adults with HIV in Malawi

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2024 May 16

PMID 38755632

Authors

Thulani Maphosa

Shalom Dunga

Lucky Makonokaya

Godfrey Woelk

Alice Maida

Alice Wang

Allan Ahimbisibwe

Rachel K Chamanga

Suzgo B Zimba

Dumbani Kayira

Rhoderick Machekano

Affiliations

Soon will be listed here.

Abstract

Background: The introduction of dolutegravir (DTG) in treating HIV has shown enhanced efficacy and tolerability. This study examined changes in weight gain and body mass index (BMI) at 6- and 12-months after post-initiating antiretroviral therapy (ART), comparing people living with HIV (PLHIV) on DTG-based regimens with those on non-DTG-based regimens in Malawi.

Methods: Retrospective cohort data from 40 public health facilities in Malawi were used, including adult ART patients (aged ≥ 15 years) from January 2017 to March 2020. The primary outcomes were BMI changes/transitions, with secondary outcomes focused on estimating the proportion of mean weight gain > 10% post-ART initiation and BMI category transitions. Descriptive statistics and binomial regression were used to estimate the unadjusted and adjusted relative risks (RR) of weight gain of more than ( >) 10%.

Results: The study included 3,520 adult ART patients with baseline weight after ART initiation, predominantly female (62.7%) and aged 25-49 (61.1%), with a median age of 33 years (interquartile range (IQR), 23-42 years). These findings highlight the influence of age, ART history, and current regimen on weight gain. After 12months follow up, compared to those aged 15-24 years, individuals aged 25-49 had an Adjusted RR (ARR) of 0.5 (95% Confidence Interval (CI): 0.35-0.70), suggesting a 50% reduced likelihood of > 10% weight gain after post-ART initiation. Similarly, those aged 50 + had an ARR of 0.33 (95% CI: 0.20-0.58), indicating a 67% decreased likelihood compared to the youngest age group 15-24 years. This study highlights the positive impact of DTG-based regimens, revealing significant transitions from underweight to normal BMI categories at 6- and 12-months post-initiation.

Conclusion: This study provides insights into weight gain patterns in patients on DTG-based regimens compared with those on non-DTG regimens. Younger individuals (15-24 years) exhibited higher odds of weight gain, suggesting a need for increased surveillance in this age group. These findings contribute to the understanding DTG's potential effects on weight gain, aiding clinical decision making. Further research is required to comprehensively understand the underlying mechanisms and long-term implications of weight gain in patients receiving DTG-based regimens.

References

Kumar S, Samaras K . The Impact of Weight Gain During HIV Treatment on Risk of Pre-diabetes, Diabetes Mellitus, Cardiovascular Disease, and Mortality. Front Endocrinol (Lausanne). 2018; 9:705. PMC: 6277792. DOI: 10.3389/fendo.2018.00705. View

Walmsley S, Baumgarten A, Berenguer J, Felizarta F, Florence E, Khuong-Josses M . Brief Report: Dolutegravir Plus Abacavir/Lamivudine for the Treatment of HIV-1 Infection in Antiretroviral Therapy-Naive Patients: Week 96 and Week 144 Results From the SINGLE Randomized Clinical Trial. J Acquir Immune Defic Syndr. 2015; 70(5):515-9. PMC: 4645960. DOI: 10.1097/QAI.0000000000000790. View

Esber A, Chang D, Iroezindu M, Bahemana E, Kibuuka H, Owuoth J . Weight gain during the dolutegravir transition in the African Cohort Study. J Int AIDS Soc. 2022; 25(4):e25899. PMC: 9008168. DOI: 10.1002/jia2.25899. View

Calza L, Colangeli V, Borderi M, Bon I, Borioni A, Volpato F . Weight gain in antiretroviral therapy-naive HIV-1-infected patients starting a regimen including an integrase strand transfer inhibitor or darunavir/ritonavir. Infection. 2019; 48(2):213-221. DOI: 10.1007/s15010-019-01376-5. View

Tshikuka J, Magafu M, Rankgoane-Pono G, Mwita J, Masupe T, Hamda S . Overweight and Obesity among Recipients of Antiretroviral Therapy at HIV Clinics in Gaborone, Botswana: Factors Associated with Change in Body Mass Index. AIDS Res Treat. 2020; 2020:8016791. PMC: 7199624. DOI: 10.1155/2020/8016791. View

Lee Y, Lin K, Cheng S, Lu P, Wang N, Ho M . Dual therapy with dolutegravir plus boosted protease inhibitor as maintenance or salvage therapy in highly experienced people living with HIV. Int J Antimicrob Agents. 2021; 58(3):106403. DOI: 10.1016/j.ijantimicag.2021.106403. View

Kanters S, Renaud F, Rangaraj A, Zhang K, Limbrick-Oldfield E, Hughes M . 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. PMC: 9112095. DOI: 10.1016/j.eclinm.2022.101412. View

Waters L, Assoumou L, Gonzalez-Cordon A, Rusconi S, Domingo P, Gompels M . Limited Weight Impact After Switching From Boosted Protease Inhibitors to Dolutegravir in Persons With Human Immunodeficiency Virus With High Cardiovascular Risk: A Post Hoc Analysis of the 96-Week NEAT-022 Randomized Trial. Clin Infect Dis. 2022; 76(5):861-870. PMC: 7617433. DOI: 10.1093/cid/ciac827. View

Kanters S, Vitoria M, Doherty M, Socias M, Ford N, Forrest J . 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(11):e510-e520. DOI: 10.1016/S2352-3018(16)30091-1. View

10.

Fantauzzi A, Mezzaroma I . Dolutegravir: clinical efficacy and role in HIV therapy. Ther Adv Chronic Dis. 2014; 5(4):164-77. PMC: 4049127. DOI: 10.1177/2040622314530461. View

11.

Blanco J, Marcelin A, Katlama C, Martinez E . Dolutegravir resistance mutations: lessons from monotherapy studies. Curr Opin Infect Dis. 2018; 31(3):237-245. DOI: 10.1097/QCO.0000000000000453. View

12.

Hsu R, Brunet L, Fusco J, Mounzer K, LaMori J, Fusco G . Excessive Weight Gain: Current Antiretroviral Agents in Virologically Suppressed People with HIV. AIDS Res Hum Retroviruses. 2022; 38(10):782-791. DOI: 10.1089/AID.2021.0188. View

13.

McCormack P . Dolutegravir: a review of its use in the management of HIV-1 infection in adolescents and adults. Drugs. 2014; 74(11):1241-52. DOI: 10.1007/s40265-014-0256-y. View

14.

Nasreddine R, Florence E, Vandercam B, Moutschen M, Goffard J, De Munter P . Effectiveness of dolutegravir-based antiretroviral therapy in a real-world setting in a Belgian cohort of 4101 HIV patients. AIDS. 2020; 34(8):1151-1159. DOI: 10.1097/QAD.0000000000002533. View

15.

Mounzer K, Brunet L, Hsu R, Fusco J, Vannappagari V, Henegar C . Changes in Body Mass Index Associated with Antiretroviral Regimen Switch Among Treatment-Experienced, Virologically Suppressed People Living with HIV in the United States. AIDS Res Hum Retroviruses. 2021; 37(11):852-861. DOI: 10.1089/AID.2020.0287. View

16.

Cahn P, Sierra Madero J, Arribas J, Antinori A, Ortiz R, Clarke A . Dolutegravir plus lamivudine versus dolutegravir plus tenofovir disoproxil fumarate and emtricitabine in antiretroviral-naive adults with HIV-1 infection (GEMINI-1 and GEMINI-2): week 48 results from two multicentre, double-blind, randomised,.... Lancet. 2018; 393(10167):143-155. DOI: 10.1016/S0140-6736(18)32462-0. View

17.

Bourgi K, Ofner S, Musick B, Griffith B, Diero L, Wools-Kaloustian K . Weight Gain Among Treatment-Naïve Persons With HIV Receiving Dolutegravir in Kenya. J Acquir Immune Defic Syndr. 2022; 91(5):490-496. PMC: 9814314. DOI: 10.1097/QAI.0000000000003087. View

18.

Bourgi K, Jenkins C, Rebeiro P, Palella F, Moore R, Altoff K . Weight gain among treatment-naïve persons with HIV starting integrase inhibitors compared to non-nucleoside reverse transcriptase inhibitors or protease inhibitors in a large observational cohort in the United States and Canada. J Int AIDS Soc. 2020; 23(4):e25484. PMC: 7159248. DOI: 10.1002/jia2.25484. View

19.

Wijting I, Rutsaert S, Rokx C, Burger D, Verbon A, van Kampen J . Predictors of virological failure in HIV-1-infected patients switching to dolutegravir maintenance monotherapy. HIV Med. 2018; 20(1):63-68. PMC: 6586017. DOI: 10.1111/hiv.12675. View