Assessment of weight gain in adult patients living with HIV receiving first-line dolutegravir-based or efavirenz-based ART regimens in routine care clinics in Tshwane district, South Africa: An observational study

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine Pub Date : 2024-03-22 DOI:10.1111/hiv.13638

Shobna Sawry, Kassahun Ayalew, Gloria Maimela, Melissa Briggs-Hagen, Marelize van Wyk-Heath, Simangele Mthethwa, Sannie Shai, Nkululeko N. Mngomezulu, Lawrence Tlhowe, Josephine Achere-Darko, Jason Bedford, Catherine E. Martin, Lee Fairlie, John Imrie

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引用次数: 0

Abstract

Introduction

Although dolutegravir (DTG) is deemed stable, safe, cost-effective, and clinically beneficial, it also carries the risk of side effects, including observed weight gain among patients on DTG-based antiretroviral therapy (ART) regimens. We compared weight changes among adults (≥18 years) initiating tenofovir disoproxil fumarate, lamivudine, and dolutegravir (TLD) or tenofovir disoproxil fumarate, emtricitabine, and efavirenz (TEE) regimens and those switching from TEE to TLD (TEE-to-TLD switchers) in three large primary care facilities in South Africa

Methods

We conducted a retrospective longitudinal record review using patient medical records, extracting relevant demographic and clinical data from October 2018 to June 2021 from randomly selected adults who initiated TLD or TEE (initiators) and adult TEE-to-TLD switchers. We assessed weight, body mass index (BMI), and percentage weight changes for both groups and fitted linear regression and generalized linear models to determine factors associated with weight and BMI change and percentage weight change ≥10%, respectively, among treatment initiators. We fitted linear mixed-effect models among TEE-to-TLD switchers to consider repeated measures.

Results

Of 860 initiators, 450 (52.3%) initiated on TEE and 410 (47.7%) on TLD, with median follow-up of 1.4 years and 1.0 year, respectively. At initiation, 43.3% on TEE and 40.8% on TLD were overweight or obese. TLD initiators had an adjusted higher mean weight gain of 1.6 kg (p < 0.001) and mean BMI gain of 0.51 kg/m² (p < 0.001) than TEE initiators. Independent risk factors for higher mean weight and BMI included age ≥50 years, male, on ART for >12 months, initial BMI of <18.5 kg/m², and CD4 counts <200 cells/μL.

Of 298 TEE-to-TLD switchers, 36.6% were overweight or obese at TEE initiation. Comparing before and after TLD switch, TEE-to-TLD switchers had an adjusted mean weight of 1.2 kg less while on TLD (p = 0.026). Being overweight and CD4 counts >350 cells/μL were independent risk factors for lower weight gain after TLD switch.

Conclusions

We report more weight gain among TLD than among TEE initiators, although to a lesser extent than previously reported. TEE-to-TLD switchers experienced less weight gain after TLD switch; return to health before receiving TLD may be a contributory factor. The current findings are reassuring for those switching to a DTG-based regimen

Abstract Image

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南非 Tshwane 地区常规护理诊所中接受基于多鲁特韦酯或依非韦伦的一线抗逆转录病毒疗法的成年 HIV 感染者体重增加情况评估：一项观察性研究。

简介尽管多鲁曲韦（DTG）被认为是稳定、安全、具有成本效益且对临床有益的药物，但它也有副作用的风险，包括在接受基于 DTG 的抗逆转录病毒疗法（ART）治疗的患者中观察到的体重增加。我们比较了南非三家大型基层医疗机构中开始接受富马酸替诺福韦二吡呋酯、拉米夫定和多罗替拉韦（TLD）或富马酸替诺福韦二吡呋酯、恩曲他滨和依非韦伦（TEE）治疗方案的成人（≥18 岁）和从 TEE 转为 TLD 的成人（TEE-to-TLD 转换者）的体重变化方法：我们利用患者病历进行了一次回顾性纵向记录审查，提取了 2018 年 10 月至 2021 年 6 月期间随机抽取的启动 TLD 或 TEE 的成人（启动者）和从 TEE 转为 TLD 的成人的相关人口统计学和临床数据。我们评估了两组患者的体重、体重指数（BMI）和体重变化百分比，并分别拟合了线性回归模型和广义线性模型，以确定与治疗启动者的体重和BMI变化以及体重变化百分比≥10%相关的因素。我们在 TEE 到 TLD 转换者中建立了线性混合效应模型，以考虑重复测量：在 860 名初始治疗者中，450 人（52.3%）开始接受 TEE 治疗，410 人（47.7%）开始接受 TLD 治疗，随访中位数分别为 1.4 年和 1.0 年。开始时，43.3% 的 TEE 和 40.8% 的 TLD 患者超重或肥胖。TLD启动者的调整后平均体重增加较高，为1.6千克（p 2（p 12个月、初始BMI为2、CD4计数为350个细胞/μL是TLD转换后体重增加较低的独立风险因素：我们的报告显示，TLD 患者的体重增加多于 TEE 患者，但增加程度低于之前的报告。从 TEE 到 TLD 的转换者在转换 TLD 后体重增加较少；在接受 TLD 之前恢复健康可能是一个促成因素。目前的研究结果让那些改用基于 DTG 的治疗方案的患者感到放心。

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来源期刊

HIV Medicine 医学-传染病学

CiteScore

5.10

自引率

10.00%

发文量

167

审稿时长

6-12 weeks

期刊介绍： HIV Medicine aims to provide an alternative outlet for publication of international research papers in the field of HIV Medicine, embracing clinical, pharmocological, epidemiological, ethical, preclinical and in vitro studies. In addition, the journal will commission reviews and other feature articles. It will focus on evidence-based medicine as the mainstay of successful management of HIV and AIDS. The journal is specifically aimed at researchers and clinicians with responsibility for treating HIV seropositive patients.