Longitudinal Weight Gain Trajectories After Initiation of Dolutegravir-Based Antiretroviral Therapy: A Retrospective...

Dolutegravir (DTG) is widely used in antiretroviral therapy (ART) for its high efficacy and favorable tolerability. However, emerging evidence has raised concerns regarding weight gain and potential metabolic consequences associated with DTG use, with limited longitudinal data from Asian populations. This study aimed to evaluate longitudinal weight changes among people living with HIV (PLWH) receiving DTG-containing regimens and to determine whether weight trajectories differ across key demographic and clinical subgroups. We conducted a retrospective cohort study of adult PLWH who initiated DTG-based ART at a tertiary referral center between January 2020 and June 2022, with follow-up through June 2024. Participants with complete weight data at baseline, 6, 12, 18, and 24 months were included. Weight trajectories were analyzed using repeated-measures ANCOVA, adjusting for sex, age group, ART backbone (TDF-based vs. non-TDF-based), baseline body mass index (BMI), baseline weight, and baseline CD4 cell count. A total of 157 participants (59.2% male; mean age 50.4 years) were included. Mean body weight increased significantly over 24 months in both sexes. Greater numerical weight gain was observed among participants aged ≥ 50 years and those receiving non-TDF-based regimens. However, only ART backbone demonstrated a significant time-by-subgroup interaction. Participants with baseline CD4 counts < 200 cells/mm³ and lower baseline BMI demonstrated numerically greater weight increases over time. No significant time-by-sex, time-by-age, time-by-BMI, or time-by-CD4 interactions were observed, indicating broadly similar longitudinal trajectories across these subgroups after adjustment. DTG-containing ART was associated with modest but significant weight gain over 24 months in this Thai cohort. ART backbone, differences between TDF-based and non-TDF-based regimens, was the primary factor associated with differential weight trajectories. These findings support monitoring of routine weight and metabolic parameters and highlight the importance of individualized ART selection to optimize long-term metabolic health.