Affiliation:
1. Newlands Clinic Harare Zimbabwe
2. Institute of Social and Preventive Medicine University of Bern Bern Switzerland
3. Graduate School of Health Sciences University of Bern Bern Switzerland
4. Centre for Infectious Disease Epidemiology and Research School of Public Health University of Cape Town Cape Town South Africa
5. Population Health Sciences, Bristol Medical School University of Bristol Bristol UK
6. Department of Pharmacy and Pharmaceutical Sciences University of Zimbabwe Harare Zimbabwe
7. Innovation Hub University of Zimbabwe Harare Zimbabwe
Abstract
AbstractIntroductionDolutegravir (DTG) is widely used for antiretroviral therapy (ART). We compared weight and blood pressure trends and examined the association between high blood pressure and weight gain among people living with HIV (PLHIV) switching to or starting DTG‐based, efavirenz (EFV)‐based and ritonavir‐boosted atazanavir (ATV/r)‐based ART in Zimbabwe.MethodsPLHIV aged 18 years or older who started or switched to DTG, EFV or ATV/r‐based ART between January 2004 and June 2022 at Newlands Clinic in Harare, Zimbabwe, were eligible. Weight was measured at all visits (Seca floor scales); blood pressure only at clinician‐led visits (Omron M2 sphygmomanometer). We used Bayesian additive models to estimate trends in weight gain and the proportion with high blood pressure (systolic >140 mmHg or diastolic >90 mmHg) in the first 2 years after starting or switching the regimen. Finally, we examined whether trends in the proportion with high blood pressure were related to weight change.ResultsWe analysed 99,969 weight and 35,449 blood pressure records from 9487 adults (DTG: 4593; EFV: 3599; ATV/r: 1295). At 24 months after starting or switching to DTG, estimated median weight gains were 4.54 kg (90% credibility interval 3.88−5.28 kg) in women and 3.71 kg (3.07−4.45 kg) in men, around twice that observed for ATV/r and over four‐times the gain observed for EFV. Prevalence of high blood pressure among PLHIV receiving DTG‐based ART increased from around 5% at baseline to over 20% at 24 months, with no change in PLHIV receiving EFV‐ or ATV/r‐based ART. High blood pressure in PLHIV switching to DTG was associated with weight gain, with stronger increases in the proportion with high blood pressure for larger weight gains.ConclusionsAmong PLHIV starting ART or switching to a new regimen, DTG‐based ART was associated with larger weight gains and a substantial increase in the prevalence of high blood pressure. Routine weight and blood pressure measurement and interventions to lower blood pressure could benefit PLHIV on DTG‐based ART. Further studies are needed to elucidate the mechanisms and reversibility of these changes after discontinuation of DTG.
Funder
National Institute of Allergy and Infectious Diseases
National Institute of Child Health and Human Development
National Cancer Institute
National Institute on Drug Abuse
National Heart, Lung, and Blood Institute
National Institute on Alcohol Abuse and Alcoholism
National Institute of Diabetes and Digestive and Kidney Diseases
Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
Fogarty International Center
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