Effect of dolutegravir-based antiretroviral therapy transition on body mass index in adolescents living with HIV: secondary analysis of data from the ANRS 12225 Pediacam III cohort in Cameroon

BACKGROUND: Dolutegravir (DTG) is widely used in people living with HIV, but its potential association with weight gain remains insufficiently documented in adolescents. This study assessed the effect of transitioning to a DTG-based regimen on body mass index (BMI) in adolescents living with HIV (ALHIV) in Cameroon. METHODS: Data prospectively collected between 2020 and 2024 from the ANRS 12,225-Pediacam III cohort were retrospectively analyzed. The analysis included 105 ALHIV who switched to DTG (HI-DTG), 18 ALHIV who did not (HI-nDTG), and 180 HIV-uninfected adolescents born to HIV-positive mothers (HEU, n = 79) or to HIV-negative mothers (HUU, n = 101). Body mass index (BMI) trajectories and levels were compared across groups using linear mixed-effects models, as well as before and after the DTG transition within the HI-DTG group. RESULTS: The median age was 11.5 years (IQR:11.0-12.5), which significant differences between groups. Overall, 51.6% were female. The median follow-up on DTG was 2.6 years (IQR:2.0-3.2). BMI trajectories differed across groups (p = 0.045) after adjustment for sex, age, baseline BMI z-score, household income, and interaction terms. Compared with HI-nDTG as the reference group, the HI-DTG group showed a modest but significant greater annual increase in BMI (0.32 kg/m²/year; 95% CI: 0.03-0.62; p = 0.03), with no differences observed for HEU or HUU. Baseline BMI z-score, household income, and female sex were more strongly associated with BMI over time than DTG use. Within the HI-DTG group, a mean annual increase of 0.19 kg/m²/year was observed after switching to DTG. CONCLUSION: Switching to DTG was associated with an increase in BMI among ALHIV. These findings underscore the need for close metabolic monitoring to prevent long-term cardiometabolic complications.