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

Objectives
To analyze weight changes associated with dolutegravir- versus efavirenz-based antiretroviral therapy (ART) in people living with HIV (PLHIV) 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, non-pregnant PLHIV 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 1,205 PLHIV at ART start (median age 40 years (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%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 counts ≥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/m2. 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.