Antiretroviral drugs cause obesity in HIV+ people, study says

HIV-positive people on antiretroviral (ARV) treatment gained weight three times as fast as HIV-negative people of similar age, a large study has revealed.

A new pooled analysis of randomised controlled clinical trials of people starting HIV treatment for the first time found that newer ARV classes were associated with greater weight gain.

The findings released Wednesday during a 23rd virtual international Aids conference reveals that there are several causes of the weight gains, and some specific antiretroviral have been linked including dolutegravir-based HIV treatment.

The study sampled 8,256 people with HIV and 129,966 HIV-negative controls from the Kaiser Permanente database of people receiving care in California, Virginia, Maryland and Washington D.C.

The HIV-positive population had a median age of 41, with 88 per cent male, 36 per cent white, 26 per cent black, 26 per cent Latino and six per cent Asians.

At the beginning of the study, people with HIV had a lower average body mass than HIV-negative people. People with HIV gained weight three times as quickly as HIV-negative people and, after 12 years of follow-up, had a similar body mass to HIV-negative people.

The researchers stress that weight gain will exacerbate the risk of co-morbidities already more common in people with HIV, especially cardiovascular disease. Another prospective study in four African countries presented to the conference has shown that people taking dolutegravir-based treatment had significantly become bigger as compared to other people with HIV but on different drugs.

The study sampled 742 people with HIV at 12 different treatment sites in Kenya, Nigeria, Tanzania and Uganda.

The study compared the 742 people who began treatment with tenofovir, lamivudine and dolutegravir with 1,212 people who had not started antiretroviral therapy or who received a non-dolutegravir antiretroviral regimen.

The participants took dolutegravir for a median of 255 days and 451 participants became overweight. The incidence of overweight was 72 cases per 1,000 people overall and 98 cases per 1,000 people in dolutegravir recipients.

Those who were prescribed dolutegravir had an 85 per cent higher rate of becoming overweight or obese than people taking a non-dolutegravir regimen.

The findings were presented by Dr Julie Ake of the US Military HIV Research Program at Walter Reed Army Institute of Research.

“Our findings raise the possibility that modern [ARV treatment] regimens with improved tolerability and potency may lead to weight gain in some [people with HIV], necessitating increased clinical attention to the maintenance of healthy body weight, lifestyle modification and exercise at [treatment]initiation,” the authors concluded.

The WHO recommended dolutegravir-based treatment as its preferred option in 2017 and strongly recommended it for all adults in 2019, encouraging all countries to update their guidelines and transition to dolutegravir-based treatment as quickly as possible.

Kenya introduced DTG in 2017, becoming the first country in Africa to do so amid fears about the risk of defects in the brain, spine or spinal cord being higher for babies of women on DTG arose following a study in Botswana.

Kenya has since updated its HIV therapy guidelines to show DTG as the first-line treatment option.