Impact of switching to a dolutegravir‐based regimen on body weight changes: insights from West African adult HIV cohorts
Abstract Introduction Adverse metabolic effects related to dolutegravir (DTG) are increasingly reported as countries are adopting DTG‐based regimens as first‐line antiretroviral therapy (ART), but there is limited data from sub‐Saharan Africa. We explored changes in body weight pre‐ and post‐switch...
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2024-12-01
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| Series: | Journal of the International AIDS Society |
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| Online Access: | https://doi.org/10.1002/jia2.26371 |
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| author | Thierry Tiendrebeogo Karen Malateste Armel Poda Albert Minga Cecile D. Lahiri Oliver Ezechi Didier K. Ekouevi Igho Ofotokun Antoine Jaquet the IeDEA West Africa Collaboration |
| author_facet | Thierry Tiendrebeogo Karen Malateste Armel Poda Albert Minga Cecile D. Lahiri Oliver Ezechi Didier K. Ekouevi Igho Ofotokun Antoine Jaquet the IeDEA West Africa Collaboration |
| author_sort | Thierry Tiendrebeogo |
| collection | DOAJ |
| description | Abstract Introduction Adverse metabolic effects related to dolutegravir (DTG) are increasingly reported as countries are adopting DTG‐based regimens as first‐line antiretroviral therapy (ART), but there is limited data from sub‐Saharan Africa. We explored changes in body weight pre‐ and post‐switch to a DTG‐based regimen and assessed the association between DTG switch and significant weight gain (SWG) defined as a ≥10% increase over a 12‐month period in people living with HIV (PLHIV) on ART in West Africa. Methods We first included all PLHIV followed in the IeDEA West Africa cohorts between January 2017 and June 2021, with a documented switch to DTG during 2019–2021 and in care ≥36 months at the day of switch. Weight change was estimated using a two slope piecewise linear mixed model with change point at the switch date. Secondly, we emulated a sequence of target trials (ETT) based on the observational data, performing pooled logistic regression analysis to compare SWG occurrence between PLHIV who switched to DTG and those who did not. Results We first included 6705 PLHIV from Burkina Faso, Côte d'Ivoire and Nigeria. Their median age at the time of switch was 48 years (IQR: 42–54) with a median follow‐up of 9 years (IQR: 6–12), 63% were female. Most patients switched from efavirenz (EFV)‐based ART (56.6%) and nevirapine (NVP)‐based ART (30.9%). The overall post‐switch annual average weight gain (AAWG) was significantly elevated at 3.07 kg/year [95% CI: 2.33–3.80] compared to the pre‐switch AWG which stood at 0.62 kg/year [95% CI: 0.36–0.88]. The post‐switch AWG was greater in patients previously on EFV and protease inhibitor (PI)‐based ART compared to those on NVP‐based ART. The pooled logistic regression analyses of a sequence of 24 ETT, including 9598 person‐trials, switching to DTG was significantly associated with an SWG (aOR = 2.54; 95% CI = 2.18–2.97). Conclusions In West Africa, a 12‐month DTG exposure was associated with substantial weight gain, especially in PLHIV previously on EFV and PI‐based ARTs. Continuous weight monitoring and metabolic profiling is imperative in HIV cohorts to delineate the long‐term cardiometabolic impact of DTG as patients with, or at elevated risk for cardiovascular diseases might benefit from alternative ART regimens. |
| format | Article |
| id | doaj-art-66d2f9f656614dfa950b653179ac3655 |
| institution | DOAJ |
| issn | 1758-2652 |
| language | English |
| publishDate | 2024-12-01 |
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| series | Journal of the International AIDS Society |
| spelling | doaj-art-66d2f9f656614dfa950b653179ac36552025-08-20T02:39:12ZengWileyJournal of the International AIDS Society1758-26522024-12-012712n/an/a10.1002/jia2.26371Impact of switching to a dolutegravir‐based regimen on body weight changes: insights from West African adult HIV cohortsThierry Tiendrebeogo0Karen Malateste1Armel Poda2Albert Minga3Cecile D. Lahiri4Oliver Ezechi5Didier K. Ekouevi6Igho Ofotokun7Antoine Jaquet8the IeDEA West Africa CollaborationUniversity of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre Bordeaux FranceUniversity of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre Bordeaux FranceDepartment of Infectious Diseases Université Nazi Boni Bobo‐Dioulasso Burkina FasoCentre médical de Suivi des Donneurs de Sang (CMSDS), Centre National de Transfusion Sanguine Côte d'Ivoire (CNTSCI) Abidjan Côte d'IvoireDivision of Infectious Diseases Department of Medicine Emory University School of Medicine Atlanta Georgia USAOffice of the Central Secretariat Nigeria Institute for Medical Research Lagos NigeriaUniversity of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre Bordeaux FranceDivision of Infectious Diseases Department of Medicine Emory University School of Medicine Atlanta Georgia USAUniversity of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre Bordeaux FranceAbstract Introduction Adverse metabolic effects related to dolutegravir (DTG) are increasingly reported as countries are adopting DTG‐based regimens as first‐line antiretroviral therapy (ART), but there is limited data from sub‐Saharan Africa. We explored changes in body weight pre‐ and post‐switch to a DTG‐based regimen and assessed the association between DTG switch and significant weight gain (SWG) defined as a ≥10% increase over a 12‐month period in people living with HIV (PLHIV) on ART in West Africa. Methods We first included all PLHIV followed in the IeDEA West Africa cohorts between January 2017 and June 2021, with a documented switch to DTG during 2019–2021 and in care ≥36 months at the day of switch. Weight change was estimated using a two slope piecewise linear mixed model with change point at the switch date. Secondly, we emulated a sequence of target trials (ETT) based on the observational data, performing pooled logistic regression analysis to compare SWG occurrence between PLHIV who switched to DTG and those who did not. Results We first included 6705 PLHIV from Burkina Faso, Côte d'Ivoire and Nigeria. Their median age at the time of switch was 48 years (IQR: 42–54) with a median follow‐up of 9 years (IQR: 6–12), 63% were female. Most patients switched from efavirenz (EFV)‐based ART (56.6%) and nevirapine (NVP)‐based ART (30.9%). The overall post‐switch annual average weight gain (AAWG) was significantly elevated at 3.07 kg/year [95% CI: 2.33–3.80] compared to the pre‐switch AWG which stood at 0.62 kg/year [95% CI: 0.36–0.88]. The post‐switch AWG was greater in patients previously on EFV and protease inhibitor (PI)‐based ART compared to those on NVP‐based ART. The pooled logistic regression analyses of a sequence of 24 ETT, including 9598 person‐trials, switching to DTG was significantly associated with an SWG (aOR = 2.54; 95% CI = 2.18–2.97). Conclusions In West Africa, a 12‐month DTG exposure was associated with substantial weight gain, especially in PLHIV previously on EFV and PI‐based ARTs. Continuous weight monitoring and metabolic profiling is imperative in HIV cohorts to delineate the long‐term cardiometabolic impact of DTG as patients with, or at elevated risk for cardiovascular diseases might benefit from alternative ART regimens.https://doi.org/10.1002/jia2.26371HIVantiretroviral therapydolutegravirweight gainobservational cohort studyWest Africa |
| spellingShingle | Thierry Tiendrebeogo Karen Malateste Armel Poda Albert Minga Cecile D. Lahiri Oliver Ezechi Didier K. Ekouevi Igho Ofotokun Antoine Jaquet the IeDEA West Africa Collaboration Impact of switching to a dolutegravir‐based regimen on body weight changes: insights from West African adult HIV cohorts Journal of the International AIDS Society HIV antiretroviral therapy dolutegravir weight gain observational cohort study West Africa |
| title | Impact of switching to a dolutegravir‐based regimen on body weight changes: insights from West African adult HIV cohorts |
| title_full | Impact of switching to a dolutegravir‐based regimen on body weight changes: insights from West African adult HIV cohorts |
| title_fullStr | Impact of switching to a dolutegravir‐based regimen on body weight changes: insights from West African adult HIV cohorts |
| title_full_unstemmed | Impact of switching to a dolutegravir‐based regimen on body weight changes: insights from West African adult HIV cohorts |
| title_short | Impact of switching to a dolutegravir‐based regimen on body weight changes: insights from West African adult HIV cohorts |
| title_sort | impact of switching to a dolutegravir based regimen on body weight changes insights from west african adult hiv cohorts |
| topic | HIV antiretroviral therapy dolutegravir weight gain observational cohort study West Africa |
| url | https://doi.org/10.1002/jia2.26371 |
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