Background
Background: Dolutegravir (DTG) based antiretroviral therapy (DTG-ART) is preferred first-line for persons with HIV (PWH), and yet implicated with weight gain. We compared cardiometabolic health risk by DTG-ART.
Methods
Methods: ART-experienced PWH enrolled via Makerere University IDI-ART clinic in Uganda (2021), cross-sectional comparisons of DTG-ART and age- and sex-matched controls (group A), and pre- and 6-months post-DTG-ART switch comparisons (group B). We used gold-standard measures of liver fat (Fibroscan controlled attenuation parameter (CAP)), and DEXA for body fat composition (group B only). Modified Poisson regression with robust variance estimated adjusted prevalence risk (aPR), and 95% confidence intervals (CI) for cardiometabolic risk, adjusting for age, ART duration, education, viral load and CD4 count, additionally for women, parity and obesogenic contraceptives use.
Results
Results: For group A (n=500), 65.2% were women, median age (IQR), 39 (34-46) years compared to men, 45 (38-50) years; 50.2% DTG-ART, 67.1% tenofovir ART backbone, 86.2% virally suppressed (<20 copies/ml). In adjusted analyses stratified by sex, null associations with DTG-ART were observed for anthropometric measures, blood pressure (BP), blood sugar, liver fat CAP >270 dB/m, dyslipidaemia and metabolic syndrome, see figure 1, and similarly in separate analyses stratified by age (≥50 years), DTG-ART duration (>12 months), and ART pre-DTG switch, respectively. Notable exceptions include high BP (≥130/85 mmHg) in men within normal range BMI, aPR (95% CI), 1.98 (1.22, 3.19), pre-DTG ART sans efavirenz, 1.64 (1.10, 2.46); DTG-ART ≥12 months was protective against hypertriglyceridemia ≥150 mg/dl, in women, aPR (95% CI), 0.47 (0.26, 0.83), and men, 0.53 (0.32, 0.87); but associated with HDL<50mg/dl in women (<50 years, 1.44 (1.12, 1.87), overweight/obese, 1.41 (1.10, 1.80) and when compared to NNRTI-ART controls, 1.66 (1.10, 2.56)). For group B (n=50), there were no differences 6 months after DTG-ART switch regarding body fat DEXA measures, liver fat CAP scores, BP, blood sugar, while lipid measures improved significantly in both men and women.
Conclusions
Conclusions: Apart from BP in men and HDL in women, DTG-ART use in virally suppressed Ugandan PWH appeared to be lipo-protective or neutral regarding cardiometabolic health risks. Interpretation of these data is complex given concurrent use of potentially weight-attenuating TDF or efavirenz (controls or pre-DTG), considerations for future studies.
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