The World Health Organisation (WHO), in 2019, formally recommended the drug dolutegravir (DTG) as the preferred antiretroviral therapy (ART) for people living with HIV in low and middle-income countries (LMICs), citing that it is more effective and tolerable, less costly, and less prone to developing drug resistance than the previously recommended first-line treatment efavirenz (EFV).
Since then, several clinical trials have shown that DTG is associated with substantial weight gain among people taking it, compared to people who take EFV.
Now a new study, published in the journal eClinicalMedicine, has confirmed these findings about DTG and weight gain, and it also found that people living with HIV who take DTG may also have a higher risk of developing high blood pressure.
The team matched 794 patients who switched from DTG TO EFV, to 794 patients who remained on EFV.
The findings showed that patients on ART gained on average 1.78 kg in 12 months after switching from EFV to DTG, compared to patients who remained on EFV. The results also showed that patients taking DTG increased their risk of developing hypertension by 14 percentage points, compared to patients who remained on EFV.
While “the blood pressure rise data is less clear” it is “in some ways more worrying if linked to the drug, as it appears fairly quickly after exposure”, said lead author Dr. Alana Brennan, Assistant Professor of global health at Boston University in the US.
In addition to the average increase in weight, the findings showed that, regardless of whether patients switched to DTG, patients who had a lower BMI (less than 30), were younger than 50 years old, and received ART treatment for less than a year gained more weight than those who had higher BMI, were 50 or older, or whose regimen extended beyond 12 months, respectively.
The team also observed that patients with existing high blood pressure at the start of the study had an increased risk of hypertension 12 months later. Female patients also had a slightly higher risk of developing high blood pressure, compared to male patients.
But the team cautions not to dismiss the effectiveness of DTG as a life-saving HIV treatment.
“It is important not to leap to conclusionsawe need to interrogate existing datasets quickly — blood pressure is routinely collected in pretty much everyone, so we should be able to quickly see whether this is something to worry about or not,” said Dr. Francois Venter, research professor at the University of the Witwatersrand in South Africa.
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