Background
The transition to integrase inhibitors has been associated with weight gain and increases in cardiometabolic risk factors, but evidence for the impact of this transition over longer time horizons in populations with HIV-negative comparators is limited. We evaluated the impact of the switch from efavirenz to dolutegravir (DTG) on weight and a suite of cardiometabolic risk factors among middle-aged and older adults in South Africa.
Methods
We analyzed data from a longitudinal population-based cohort of adults ≥40 years in a rural sub-district of Mpumalanga Province (HAALSA-HAALSI: Health and Ageing in Africa: Longitudinal Studies in South Africa Indepth). Wave 2 data were collected in Oct 2018 – Oct 2019 (before DTG rollout in South Africa) and Wave 3 in Jul 2021 – Mar 2022 (after DTG rollout). Household surveys collected data on health, socioeconomic status, anthropometrics (height, weight, hip and waist circumference), and blood pressure. Dried blood spots were tested for HIV Ag/Ab and the following antiretrovirals to define a participant’s regimen: DTG, EFV, LPV, 3TC, FTC. We assessed changes over three years between surveys in (1) BMI, (2) waist circumference, (3) waist-to-hip ratio, and (4) blood pressure. These were analyzed across four groups of people: (1) HIV+ on ART in both waves with switch to DTG [HIV+/ART/DTG]; (2) HIV+ on ART in both waves with no switch to DTG [HIV+/ART/no DTG]; (3) HIV+ not on ART [HIV+/no ART]; and (4) HIV-. Linear regression models controlled for age, sex, education and wealth.
Results
2,071 participants provided data in both waves and were categorized in the following groups: 10% HIV+/ART/DTG, 7% HIV+/ART/no DTG, 1% HIV+/no ART, and 74% HIV-. The median age was 64 years (IQR: 55-72) and 59% were female. People who switched to DTG (HIV+/ART/DTG group) had greater increases in BMI, waist circumference, and systolic blood pressure over three years compared to the HIV+/ART/no DTG and HIV- groups (Table). The impact of switching to DTG on diastolic blood pressure was greater among females: a relative increase of 2.49 mmHg (95% CI: 0.33-4.64) compared to HIV- individuals. As expected, people in the HIV+/no ART group had relatively large decreases in weight.
Conclusions
This study provides real-world evidence that switching to DTG among adults aging with HIV is associated with a risk of weight gain and increased blood pressure, especially for females. Investments in care to offset cardiometabolic health risks in people with treated HIV are urgently needed.