Weisser Maja, Mapesi Herry, Vanobberghen Fiona, Okuma James, Eichenberger Anna, Wilson Herieth Ismael, Paris Daniel Henry, Kalinjuma Aneth Vedastus, Luoga Ezekiel, Wilson Lulu, Glass Tracy Renée, Franzeck Fabian Christoph
Ifakara Health Institute, Ifakara branch, Ifakara, United Republic of Tanzania.
Swiss Tropical and Public Health Institute, Allschwil.
AIDS. 2025 Mar 15;39(4):362-372. doi: 10.1097/QAD.0000000000004085. Epub 2024 Dec 5.
To analyze weight changes associated with dolutegravir- versus efavirenz-based antiretroviral therapy (ART) in people with HIV (PWH) in rural Tanzania, where undernutrition is prevalent.
Longitudinal, observational study of the prospective Kilombero and Ulanga Antiretroviral Cohort (KIULARCO).
We included adult, ART-naïve, nonpregnant PWH initiating efavirenz-based ART 12/2016-02/2019 or dolutegravir-based ART 03/2019-12/2022. We used multivariable linear mixed-effects models to assess adjusted weight changes during 18 months after ART start and Cox regression models to assess factors associated with incident obesity, weight gain ≥10% and hypertension.
Of 1205 PWH at ART start [median age 40 years (interquartile range (IQR) 32-48); 719 (59.7%) females], 166 (13.8%) individuals were underweight and 317 (26.3%) overweight/obese; 621 (51.5%) initiated efavirenz-based and 584 (48.5%) dolutegravir-based ART. After 18 months, estimated weight gain was 5.1 kg [95% confidence interval (CI) 4.7-5.5] in the dolutegravir versus 4.0 kg (95% CI 3.7-4.4) in the efavirenz group. The weight gain difference between treatment groups was high in men (1.7 kg (95% CI 0.8-2.6; P < 0.001)), in those aged 30-49 years (1.5 kg (0.8-2.1); P < 0.001) and those with CD4 + cell count ≥500/ul (2.5 kg (1.4-3.7), P < 0.001)). Cumulative obesity incidence at 18 months was 10.9% (95% CI 8.3-14.0) in the dolutegravir and 5.1% (95% CI 3.6-7.1) in the efavirenz group. Associated factors were dolutegravir and a pre-ART body mass index (BMI) of 25-29 kg/m 2 . Dolutegravir and age, but not weight gain were associated with incident of hypertension.
Dolutegravir-based ART was associated with more weight gain, higher obesity and hypertension - especially in those with a higher pre-ART BMI compared to efavirenz-based regimens.
分析在坦桑尼亚农村地区营养不良普遍存在的情况下，接受基于多替拉韦与基于依非韦伦的抗逆转录病毒疗法（ART）的艾滋病毒感染者（PWH）的体重变化。
对前瞻性基洛姆贝罗和乌朗加抗逆转录病毒队列（KIULARCO）进行纵向观察研究。
我们纳入了2016年12月至2019年2月开始接受基于依非韦伦的ART或2019年3月至2022年12月开始接受基于多替拉韦的ART的初治、非妊娠成年PWH。我们使用多变量线性混合效应模型评估ART开始后18个月内的调整后体重变化，并使用Cox回归模型评估与新发肥胖、体重增加≥10%和高血压相关的因素。
在1205名开始接受ART的PWH中[中位年龄40岁（四分位间距（IQR）32 - 48）；719名（59.7%）为女性]，166名（13.8%）体重过轻，317名（26.3%）超重/肥胖；621名（51.5%）开始接受基于依非韦伦的ART，584名（48.5%）开始接受基于多替拉韦的ART。18个月后，多替拉韦组的估计体重增加为5.1千克[95%置信区间（CI）4.7 - 5.5]，而依非韦伦组为4.0千克（95%CI 3.7 - 4.4）。治疗组之间的体重增加差异在男性中较大（1.7千克（95%CI 0.8 - 2.6；P＜0.001）），在30 - 49岁的人群中（1.5千克（0.8 - 2.1）；P＜0.001）以及CD4 + 细胞计数≥500/μl的人群中（2.5千克（1.4 - 3.7），P＜0.001）。18个月时多替拉韦组的累积肥胖发生率为10.9%（95%CI 8.3 - 14.0），依非韦伦组为5.1%（95%CI 3.6 - 7.1）。相关因素为多替拉韦和ART前体重指数（BMI）为25 - 29kg/m²。多替拉韦和年龄与高血压的发生相关，但与体重增加无关。
与基于依非韦伦的治疗方案相比，基于多替拉韦的ART与更多的体重增加、更高的肥胖率和高血压相关，尤其是在ART前BMI较高的人群中。
