Weight and Lipid Levels in People Living With HIV and Initiating a Dolutegravir-Based Regimen in a Resource Limited Setting: A Prospective Study.

Abstract

Background: Following the 2018 World Health Organization's (WHO) guidelines on HIV treatment and management, the Zimbabwean government has embraced dolutegravir (DTG)-based regimens as the preferred first-line treatment for people living with HIV (PLWH). Despite this implementation, there remains a paucity of knowledge on the potential associations between DTG-based regimens, body weight and blood lipid levels among PLWH in Zimbabwe. Thus, the aim of this study was to investigate variances in body weight and blood lipid levels at two distinct timepoints-baseline and 6-month post-DTG initiation. Methods: We conducted this study between November 2021 and April 2023 among ART-naïve individuals initiating a DTG-based regimen. Participants were recruited from a tertiary clinic in Zimbabwe. Body weight, standing height and blood lipid levels were measured at baseline and 6-month post-DTG. Changes in weight, body mass index (BMI) and lipids levels were assessed using the paired Student's t-test and Wilcoxon signed rank test. Multivariable logistic and linear regression analysis was used to assess risk factors associated with changes in weight, BMI and lipid levels. Results: A cohort comprising 130 study participants, characterised by a mean (±SD) age of 40.0 (±11.0) years at baseline, was subjected to a 6-month regimen of DTG-based therapy. The outcomes revealed statistically significant alterations in various physiological parameters. Specifically, post the DTG-based intervention, there were substantial increases observed in body weight (p < 0.001), BMI (p=0.003), total cholesterol (TC) levels (p=0.002) and high-density lipoprotein cholesterol (HDL-C) levels (p < 0.001) in comparison to their baseline values. Intriguingly, the corresponding triglyceride (TG) levels exhibited a noteworthy decrease (p < 0.001). Notably, individuals aged 40 years or older exhibited a positive association (p=0.022) with increased TC levels and concurrent weight gain. Furthermore, current employment emerged as another factor positively linked to increased TC levels and weight gain. Conclusions: Upon the initiation of DTG, discernible elevations were observed in body weight, BMI and lipid levels. This study represents the first comprehensive assessment of lipid profiles and weight gain among this population in Zimbabwe, filling a critical gap in the existing literature. These findings, while indicative of short-term effects, underscore the imperative for further investigative efforts aimed at elucidating the prolonged consequences associated with DTG-induced weight gain and increased lipid levels and its underlying mechanisms.