IAS 2019 — ADVANCE, NAMSAL trials show progressive weight increases with dolutegravir


  • Myriam Vidal Valero
  • Conference Reports
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Takeaway

  • Dolutegravir (DTG), the preferred antiretroviral therapy (ART) for HIV, is associated with weight increases, according to results from the ADVANCE and NAMSAL trials.

Why this matters

  • DTG has been associated with weight increases and clinical obesity, more so in black people and women.
  • WHO has just recommended dolutegravir as a first-line treatment. 

Study design

  • In 96-week NAMSAL trial, 613 treatment-naive patients in Cameroon were randomly allocated to tenofovir disoproxil fumarate (TDF)/lamivudine/DTG or TDF/lamivudine/efavirenz (EFV).
  • In the 96-week ADVANCE trial, 1053 treatment-naive patients in South Africa were randomly allocated to tenofovir alafenamide (TAF)/emtricitabine/DTG, TDF/emtricitabine/DTG, or TDF/emtricitabine/EFV.
  • Both trials measured changes in body weight and BMI between treatment arms; ADVANCE also compared trunk fat. 

Key results

  • First-line DTG with TDF/lamivudine was associated with weight increases and clinical obesity (ADVANCE and NAMSAL).
  • Increased trunk and limb fat was associated with TAF/emtricitabine (ADVANCE).
  • Women experienced steeper weight increases and continuous progression of weight gain with DTG plus TAF/emtricitabine or TDF/emtricitabine (ADVANCE). 

Limitations

  • Not all participants had reached 96 weeks of follow-up. 
  • Results are from a preliminary analysis of a still-enrolling study and were presented without peer review at a conference.