Risks and possible implications of weight gain after switch to dolutegravir- in a large Ugandan cohort of people living with HIV

Objectives: We investigated weight gain amongst people living with HIV (PLWH) in Kampala after switching their antiretroviral therapy (ART) anchor drug from nevirapine, efavirenz or a protease inhibitor to dolutegravir. Design: This was a retrospective cohort analysis. Methods: Data were extracted from electronic medical records of non-pregnant PLWH who were virally suppressed on dolutegravir-based therapy for ≥12 months following switch. We studied the rate of weight gain using a piecewise spline random effects model and used Cox-proportional hazard models to describe risk factors for weight gain >10% after dolutegravir switch. We assessed the potential impact if we applied proposed switch criteria for away from dolutegravir, proposed by an expert group including ADVANCE trial investigators. Results: We included 5489 PLWH, 59.6% of whom were female, who had switched to dolutegravir after a median duration of 9.0 (IQR: 6.1–12.8) years of prior ART. The rate of weight gain was 0.12 kg/month (95% CI: 0.11 -0.14) in the first 12 months post-switch but varied by prior anchor drug. The cumulative risk of ≥ 10% weight gain by 36 months was 37.8%, and this was more likely if they were female, aged 25–49 years or their previous ART included efavirenz or a protease inhibitor but less likely if the pre-switch BMI was ≥ 25.0 kg/m 2 . Overall 15.7% would be eligible for further ART change according to proposed switch criteria. Conclusion: We found significant weight gain regardless of the pre-DTG regimen. More than a third of PLWH had weight gain >10% by 36 months.