From the Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa.
Family Center for Research with Ubuntu (FAMCRU), Cape Town, South Africa.
Pediatr Infect Dis J. 2023 Jul 1;42(7):564-572. doi: 10.1097/INF.0000000000003904. Epub 2023 Mar 14.
Although dolutegravir (DTG) has a favorable metabolic profile, it has been linked to excess weight gain. We evaluated changes in hepatic steatosis in adolescents with perinatally acquired HIV switching to DTG-containing antiretroviral therapy (ART).
Virologically suppressed adolescents switched to dolutegravir for a minimum of 4 months or on unchanged ART (84% protease inhibitor) were assessed prospectively with anthropometry, transient elastography with controlled attenuation parameter (CAP) and fasting metabolic profiles. ART regimens were determined independently of the study.
In total 68 adolescents [baseline median age 13.5 years [interquartile range (IQR): 12.5-14.4 years]; 42 (62%) female] were recruited. However, 38 remained on the same regimen and were followed for a median of 98 weeks (IQR: 48-108 weeks), and 30 switched to DTG and were followed for a median of 52 weeks (IQR: 49-101). There was no baseline difference in CAP between groups. There was no significant change in body mass index z-score in either group, but the median CAP in the DTG group decreased by -40dB/m (IQR: -51 to -31 dB/m) after a median of 44 weeks (IQR: 28-50 weeks) on DTG, compared to +1dB/m (IQR: -29 to +14 dB/m) in adolescents not switched ( P < 0 .01). Cholesterol and triglycerides were lower in those switched. Whereas hepatic steatosis prevalence decreased from 17% to 3% in adolescents who switched to dolutegravir, its prevalence doubled from 8% to 16% in those not switched ( P = 0.1).
In this exploratory study, adolescents switched to DTG-containing regimens had reduced hepatic steatosis, cholesterol and triglycerides with no excess weight gain compared to those on unchanged ART.
尽管多替拉韦（DTG）具有良好的代谢特性，但它与体重增加有关。我们评估了接受过围生期 HIV 感染的青少年切换到包含多替拉韦的抗逆转录病毒治疗（ART）后肝脂肪变性的变化。
接受过抗病毒治疗的青少年切换到多替拉韦（至少 4 个月或不变的 ART（84%蛋白酶抑制剂）），进行前瞻性人体测量学评估，使用瞬时弹性成像与受控衰减参数（CAP）和空腹代谢谱。ART 方案的确定与研究无关。
共纳入 68 名青少年（基线中位年龄 13.5 岁[四分位距（IQR）：12.5-14.4 岁]；42 名[62%]女性）。然而，38 名青少年仍在接受相同的治疗方案，并随访中位数为 98 周（IQR：48-108 周），30 名青少年切换到多替拉韦，并随访中位数为 52 周（IQR：49-101 周）。两组基线时 CAP 无差异。两组的体质指数 z 评分均无显著变化，但在多替拉韦组，中位数 CAP 在中位时间为 44 周（IQR：28-50 周）后降低了-40dB/m（IQR：-51 至-31dB/m），而未切换组则增加了 1dB/m（IQR：-29 至 14dB/m）（P < 0.01）。切换组的胆固醇和甘油三酯水平较低。在切换到多替拉韦的青少年中，肝脂肪变性的患病率从 17%降至 3%，而在未切换的青少年中，其患病率从 8%增至 16%（P = 0.1）。
在这项探索性研究中，与接受不变的 ART 的青少年相比，切换到多替拉韦治疗的青少年肝脂肪变性、胆固醇和甘油三酯降低，且无体重增加。
