Blood Pressure and Weight Changes and Incidence of Arterial Hypertension 3 Years After Switching to Dolutegravir in Treatment-Experienced Hiv-Infected Patients in Lilongwe, Malawi

Objective: The increased survival of people living with HIV (PLHIV) is accompanied by a rising number of aging patients at risk of cardiovascular disease. Dolutegravir (DTG), recommended in WHO guidelines, was reportedly associated with excess gain in body weight (BW). We evaluated changes in BW and blood pressure (BP) of PLHIV who had initiated tenofovir/lamivudine/efavirenz (TLE) and were followed for 36 months during the LighTen Cohort Study (ClinicalTrials.gov NCT02381275). As per Malawian National protocols, patients were switched almost universally to tenofovir/ lamivudine/dolutegravir (TLD) and medical care continued after completion of the study. Design and method: We retrieved data on BW, BMI, systolic and diastolic BP (sBP, dBP) of the LighTen Cohort study participants (age =>18 years) from the electronic medical record system at the Lighthouse Clinic for those, who were still in care at the clinic over a 36±4 months period after initiation of TLD. Student's t-test was used to compare changes (δ) in sBP, dBP, BW, and BMI between baseline (0m) and month 36 (36m) on TLE vs. TLD, respectively. Incident hypertension was defined as office blood pressure =>140/90 mmHg using =>2 measurements on =>2 consecutive visits. Results: Within the defined time frame, data of 590 PLHIV (348 females; 59%) could be analyzed. At the DTG switch their age (mean±sd) was 41.3±8.9 years with a median CD4 count of 467 cells/μl (interquartile range 325-623 cells/μl) and suppressed viral replication in 95% of cases. Incident hypertension was confirmed in n=24 of 497 and n=53 of 473 initially normotensive PLHIV during TLE and TLD periods, respectively (4.8% vs. 11.2%; p<0.001). The increase in BW and BMI was significantly higher on TLE compared to TLD while the changes in BP were significantly higher with TLD (see table; ∗p<0.001 TLE vs. TLD). Conclusions: Following the initial increase in BW on TLE, a higher risk of hypertension among PLHIV was associated with a switch from efavirenz to dolutegravir with only modest additional weight gain. In view of their inherent high cardiovascular risk, regular BP control with lifestyle counselling and timely initiation of antihypertensive drug treatment seem clearly indicated.