HIV / STI
Impact of Dolutegravir vs Efavirenz on Weight and Blood Pressure Among New Initiates in Johannesburg, South Africa: A 24-Month Study Amy Zheng* Amy Zheng Alana T. Brennan Eleanor J. Murray Jacob Bor Matthew P. Fox Willem DF Venter Mhairi Maskew
In 2019, South Africa’s antiretroviral therapy (ART) treatment guidelines replaced efavirenz (EFV) with dolutegravir (DTG) in first-line ART. Some studies have shown associations with increased weight and blood pressure (BP) with DTG compared to EFV. We evaluated changes in weight, body mass index (BMI), diastolic and systolic BP from baseline to 12- and baseline to 24-months in people ART naïve initiating DTG to those initiating EFV.
We conducted a prospective cohort study of 13,507 adults from the Themba Lethu Clinical Cohort in Johannesburg who newly initiated onto DTG or EFV from January 2010-December 2021. Characteristics for those who initiated DTG or EFV were balanced using inverse probability weighting (IPW) based on directed acyclic graphs. IPW for missing data and retention were also generated. Linear regression models were used to evaluate outcomes.
Among 13,507 participants, 1,878 (14%) initiated a DTG-based regimen and 11,629 (86%) initiated an EFV-based regimen. At 12-months, those who initiated a DTG-based regimen had a higher mean change in weight (2.1 kilograms (kg); 95% Confidence Interval (CI): -4.2,8.4), BMI (0.8 kg/m2; 95% CI: -1.6,3.1), and systolic BP (2.8 mmHg; 95% CI: 0.9,4.8) compared to those initiating EFV-based regimens. Diastolic BP essentially remained unchanged (-0.4 mmHg; 95% CI: -1.8,1.0) among those who initiated DTG compared to those who initiated EFV. We observed similar trends at 24-months (Table 1).
Our estimates suggest weight steadily increases over the first 24 months of DTG treatment; the greatest change in systolic BP occurs in the first 12 months, followed by a plateau. While DTG is associated with greater weight gain and increased systolic BP compared to EFV, EFV’s weight-suppressing effects may influence these results. Future studies should clarify whether these differences are driven by DTG or EFV’s effects, as this will be important for guiding treatment decisions and managing long-term health risks for patients.
