Abstract
Goal: To assess body mass index (BMI) changes in people living with HIV (PLHIV) and using antiretroviral therapy (ART) with dolutegravir (DTG) and its associated factors. Methods: Retrospective and prospective cohorts of PLHIV who started ART with DTG or used DTG after changing the therapeutic regimen, from Belo Horizonte, between February/2017 and March/2020. Data were gathered from clinical records of the Drug Logistics and Laboratory Test Control Systems. BMI changes were analyzed in the following week intervals 1-24(t24), 25-48(t48), 49-72(t73), and 73-96(t96) using the Wilcoxon test and generalized estimation equation (GEE) model, at 5% significance level. Results: A total of 614 individuals were included and average was 38.4 years old. Most were men (85.5%) and 52.3% had started ART with DTG. These individuals, and the immunosuppressed ones, showed significant increases in BMI when compared to those who used DTG after switching therapeutics or the non-immunosuppressed ones (p-value <0.05). After 96 weeks, individuals starting ART with DTG had a mean increase in BMI of 1.02 Kg/m2, whereas those who used DTG after the therapeutic change had an increase of 0.56 Kg/m2 (p<0.05). DTG use length, ART type, immune status, baseline BMI, and age were associated (p<0.05) with BMI increases. Conclusions: We observed an increase in BMI both in individuals starting ART with DTG use and those using it after changing the therapeutic regimen.
Highlights
IntroductionThe development and introduction of combination antiretroviral therapy (ART) have greatly improved the life expectancy of people living with HIV (PLHIV) by restoring immunity, delaying disease progression, and decreasing morbidity and mortality (Adam et al, 2017; Castelo Filho & Pott-Junior, 2016)
The development and introduction of combination antiretroviral therapy (ART) have greatly improved the life expectancy of people living with HIV (PLHIV) by restoring immunity, delaying disease progression, and decreasing morbidity and mortality (Adam et al, 2017; Castelo Filho & Pott-Junior, 2016).In 2017, the Clinical Protocol and Therapeutic Guidelines (PCDT), promulgated by the Brazilian Ministry of Health, recommended daily use of one 300 mg tenofovir (TDF) or 300 mg lamivudine (3TC) tablet, both nucleoside analogue reverse transcriptase (NRTI) inhibitors, associated to one 50 mg dolutegravir (DTG) tablet, an integrase inhibitor (INI), as a first-line regimen for HIV treatment (BRASIL, 2018).ART promotes immune recovery and improves survival among individuals
Little is known on the mechanisms by which DTG and other INI promote metabolic changes that lead to weight gains in individuals, but there is a hypothesis of an inflammatory action in adipose tissue from HIV infection and from ART itself (Lake, 2017)
Summary
The development and introduction of combination antiretroviral therapy (ART) have greatly improved the life expectancy of people living with HIV (PLHIV) by restoring immunity, delaying disease progression, and decreasing morbidity and mortality (Adam et al, 2017; Castelo Filho & Pott-Junior, 2016). ART promotes immune recovery and improves survival among individuals. A clinical study has demonstrated that individuals using DTG have greater body weight gains than those taking other pharmacotherapeutic regimens (Eckard & McComsey, 2020). Little is known on the mechanisms by which DTG and other INI promote metabolic changes that lead to weight gains in individuals, but there is a hypothesis of an inflammatory action in adipose tissue from HIV infection and from ART itself (Lake, 2017)
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