Effect of dolutegravir-based versus efavirenz-based antiretroviral therapy on excessive weight gain in adult treatment-naïve HIV patients at Matsanjeni Health Center, Eswatini: A retrospective cohort study

Background: Because of its effectiveness, the dolutegravir (DTG)-containing regimen is recommended for antiretroviral therapy (ART) in Eswatini. Dolutegravir (DTG)-associated weight gain is well documented, but with limited data from settings with a dual burden of HIV and overnutrition, such as Eswatini. We sought to investigate DTG-associated weight gain in adult treatment-naïve HIV patients at Matsanjeni Health Centre in Eswatini. Methods: : In a retrospective study, we analysed the BMI of 156 and 160 patients on DTG-based and EFV-based antiretroviral therapy (ART), respectively, at baseline and 24 months after ART initiation. We used the Wilcoxon rank sum test to compare the median BMI increase between both ART regimens and logistic regression to estimate the association between the ART regimen and excessive weight gain, defined as any BMI greater than the baseline BMI and greater than or equal to 25 kg/m 2 24 months post ART initiation. Results: : Overall, the median BMI increase in DTG-based patients was 1.09 (IQR: -0.28–3.28) kg/m 2 compared to 0.2 (IQR: -0.85–2.18) kg/m 2 in EFV-based patients (p value=0.001). The majority of participants (57.7%) on the DTG-based regimen had a normal baseline BMI. Of 90 patients with a normal baseline BMI, 33.3% evolved to overweight; 35% of 40 patients evolved from overweight at baseline to class 1 obesity; and 31.3% of 16 patients from class 1 obesity at baseline progressed to class 2 obesity. An excessive BMI increase was found in 35.3% of DTG-based regimen patients 24 months after initiation (p value <0.001). There was a strong association between the DTG-based regimen and excessive weight gain (p value <0.01). Conclusion: Despite its effectiveness, practitioners should consider DTG-based regimens as one of the risk factors for overweight/obesity and strengthen patients management and monitoring to prevent obesity-associated NCDs.