Effect of dolutegravir on 'Life's Simple 7' cardiovascular risk factors: A longitudinal analysis from Tanzania

We sought to investigate the differences and changes over time in Life's Simple 7 (LS7) and Pooled Cohort Equation (PCE) scores for cardiovascular diseases (CVD) risk by HIV status in the Mwanza HIV&CVD Cohort from three outpatient, facility-based HIV clinics in urban Tanzania.

Longitudinal comparative cohort study of people with HIV and people without HIV.

People with HIV were enrolled at HIV diagnosis before antiretroviral therapy (ART) initiation and followed after 2 years of dolutegravir (DTG) exposure. The differences LS7 metrics by HIV status were measured. Each LS7 metric was categorized as ideal (2 points), intermediate (1 point) and poor (0 point). PCE risk score was categorized as low (<5%), intermediate (5% to <7.5%) and high (≥7.5%). Changes over time in total LS7 score, individual LS7 metrics and PCE scores were examined in people with HIV from the pre-ART to post-DTG visits using ordinal logistic mixed-effects regression.

A total of 832 (402 people with HIV/430 people without HIV) participants were included in this analysis. Mean age was 39 (SD 10) years and 70% were female. At the post-DTG visit, mean LS7 score was 10.5 (SD 1.5), 44% of participants had ideal cardiovascular health (CVH), and mean PCE score was 2.3% (SD 3.0%). People with HIV versus people without HIV had higher odds of ideal blood pressure (BP) (adjusted odds ratio [aOR] = 1.50, 95% confidence interval [CI]: 1.14, 1.97), but 40% lower odds of achieving ideal physical activity (PA) (aOR = 0.60, 95% CI: 0.46, 0.79) during the post-DTG visit. People with HIV had a smaller increase in ideal BP compared to people without HIV, despite higher overall ideal BP at both visits. Most participants had a low PCE risk, though three times higher in males compared to females.

Traditional CVD risk factors like BP and PA remain similar by HIV status during the first 2 years of DTG exposure. Further work is needed to encourage PA among people with HIV and incorporate BP monitoring into routine HIV care.