Postpartum weight retention impacts cardiometabolic risk. Recent studies show higher weight gain with dolutegravir (DTG)-based antiretroviral therapy (ART) compared to other ART. We assessed the association of DTG with postpartum weight over time in women with HIV (WHIV) in Botswana using comparator groups of women on efavirenz (EFV) and HIV-negative (HIV-) women.
The Tshilo Dikotla study enrolled pregnant HIV- women and WHIV on either tenofovir (TDF)/emtricitabine or lamivudine (XTC)/DTG or TDF/XTC/EFV initiated during or before pregnancy. This analysis included women with weight measurements 1 to 18 months postpartum. Mixed models were fit to assess the association between HIV/ART status and postpartum weight over time, adjusting for confounders. Interaction terms between time and HIV/ART group were evaluated to assess for differences in weight trajectories. Subgroup analysis was performed among WHIV to further assess the association of DTG vs EFV and postpartum weight, adjusting for HIV specific factors.
Of 406 women, 170 received DTG and 114 EFV. Women on DTG or EFV were older than HIV- women (median age 28 vs 33 vs 25 years respectively, p<0.01), and fewer had a college education (13.5% vs 4.4% vs 29.5% respectively, p<0.01). Average weight gain per week (wk) between 2nd and 3rd trimester was highest in HIV- women (0.3 vs 0.2 for DTG vs 0.1 kg/wk for EFV, p<0.01) as was breastfeeding duration (35.7 vs. 19.0 for DTG vs. 22.6 wks for EFV, p<0.01). No differences in income, gestational diabetes (GDM), gestational age at delivery, or BMI at 1 month postpartum were noted across groups. Among WHIV, no differences in CD4 or log viral load at enrollment were noted between ART group; more women on EFV were on their ART at conception (86% vs. 35.3%, p<0.01). Compared to HIV- women, WHIV on DTG had similar postpartum weight through 18 months but were on average 5 kg heavier postpartum than WHIV on EFV (β=5.0, p<0.01) after adjusting for age, GDM, breastfeeding duration, and weight gain between 2nd and 3rd trimester. (Fig) No differences in slope trajectories were noted between groups. This association persisted in subgroup analysis of WHIV even after further adjusting for CD4, viral load, and ART at conception (β=2.4 for DTG vs. EFV, p=0.04).
WHIV on DTG have persistently higher weight through 18 months postpartum than those on EFV in Botswana but similar weight to HIV- women. Further studies to assess mechanisms of postpartum weight retention are needed.