Title

Weight gain among people living with HIV in Zambia transitioning to dolutegravir-based antiretroviral regimens containing tenofovir alafenamide versus tenofovir disoproxil fumarate

Presenter

Elizabeth Heilmann

Authors

E. Heilmann^1,2, S. Sivile^3,4, J.Z. Hines², D. Engamba⁴, K. Mweebo², M. Mwitumwa⁴, A. Mwila², D. Kampamba³, L. Chirwa⁴, C. Siangenda³, M. Itoh², L. Mulenga^3,4

Institutions

¹Public Health Institute, Oakland, United States, ²U.S. Centers for Disease Control and Prevention, Lusaka, Zambia, ³Ministry of Health, Lusaka, Zambia, ⁴University Teaching Hospital, Lusaka, Zambia

BACKGROUND: Dolutegravir (DTG)-based antiretroviral therapy (ART) might be associated with weight gain, particularly in combination with tenofovir alafenamide (TAF) versus tenofovir disoproxil fumarate (TDF). We compared weight changes among PLHIV who switched to a DTG-based regimen using data from electronic health records in Zambia.
METHODS: We conducted a retrospective cohort study of PLHIV aged =20 years at ART initiation with =2 recorded weights before and after ART switch between 2017 and August 2022. We estimated weight change over time using linear mixed effects models adjusting for age, sex, and body mass index and viral load at time of switch with participants as random intercepts and linear splines with knots at time of switch and 12-months post-switch.
RESULTS: We analyzed 140,816 records (15.1%) of PLHIV transitioned to a DTG-based regimen; 97.9% switched to DTG+TDF while 2.1% received DTG+TAF. PLHIV on DTG+TAF were older (46 vs. 39 years, p<0.001) and more were female (68.8% vs. 66.7%, p=0.016) than PLHIV on DTG+TDF. Trends in weight gain were greater among PLHIV on DTG+TAF versus DTG+TDF during all 3 time periods (before switch: ß=0.31, 95% confidence interval [CI]=0.01-0.61; =1 year post-switch: ß=1.67, 95% CI=1.40-1.94; >1 year post-switch: ß=2.19, 95% CI=1.30-3.08). Model-estimated changes in weight for PLHIV on DTG+TAF were 0.22kg/year before switching, 3.05kg in the first year after switching, and 0.49kg in the second year while for PLHIV on DTG+TDF, weight gain was 0.16kg, 1.68kg, and 0.38kg during the same periods (Figure).
CONCLUSIONS: PLHIV on ART experienced weight gain which was highest during the first year after transitioning to DTG-based regimens and in combination with TAF. Our findings provide real-world evidence of DTG- and TAF-associated weight gain from a large PLHIV population in Zambia. Given the rising burden of noncommunicable diseases among PLHIV, weight management counseling and screening for metabolic syndrome are needed for holistic clinical management of PLHIV.

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