Risks and possible implications of weight gain after switch to dolutegravir in a large Ugandan cohort of people with...

We investigated weight gain amongst people with HIV (PWH) in Kampala after switching their antiretroviral therapy (ART) anchor drug from nevirapine, efavirenz, or a protease inhibitor to dolutegravir.

This was a retrospective cohort analysis.

Data were extracted from electronic medical records of nonpregnant PWH who were virally suppressed on dolutegravir-based therapy for at least 12 months following switch. We studied the rate of weight gain using a piecewise spline random effects model and used Cox-proportional hazard models to describe risk factors for weight gain more than 10% after dolutegravir switch. We assessed the potential impact if we applied proposed switch criteria for away from dolutegravir, proposed by an expert group including ADVANCE trial investigators.

We included 5489 PWH, 59.6% of whom were female individuals, who had switched to dolutegravir after a median duration of 9 [interquartile range (IQR): 6.1-12.8] years of prior ART. The rate of weight gain was 0.12 kg/month [95% confidence interval (CI): 0.11 to -0.14] in the first 12 months postswitch but varied by prior anchor drug. The cumulative risk of at least 10% weight gain by 36 months was 37.8%, and this was more likely if they were female, aged 25-49 years or their previous ART included efavirenz or a protease inhibitor but less likely if the preswitch BMI was at least 25 kg/m 2 . Overall, 15.7% would be eligible for further ART change according to proposed switch criteria.

We found significant weight gain regardless of the pre- dolutegravir (DTG) regimen. More than a third of PWH had weight gain of more than 10% by 36  months.