Effect of dolutegravir-based antiretroviral therapy transition on body mass index in adolescents living with HIV: secondary analysis of data from the ANRS 12225 Pediacam III cohort in Cameroon.

BACKGROUND

Dolutegravir (DTG) is widely used in people living with HIV, but its potential association with weight gain remains insufficiently documented in adolescents. This study assessed the effect of transitioning to a DTG-based regimen on body mass index (BMI) in adolescents living with HIV (ALHIV) in Cameroon.

METHODS

Data prospectively collected between 2020 and 2024 from the ANRS 12,225-Pediacam III cohort were retrospectively analyzed. The analysis included 105 ALHIV who switched to DTG (HI-DTG), 18 ALHIV who did not (HI-nDTG), and 180 HIV-uninfected adolescents born to HIV-positive mothers (HEU, n = 79) or to HIV-negative mothers (HUU, n = 101). Body mass index (BMI) trajectories and levels were compared across groups using linear mixed-effects models, as well as before and after the DTG transition within the HI-DTG group.

RESULTS

The median age was 11.5 years (IQR:11.0-12.5), which significant differences between groups. Overall, 51.6% were female. The median follow-up on DTG was 2.6 years (IQR:2.0-3.2). BMI trajectories differed across groups (p = 0.045) after adjustment for sex, age, baseline BMI z-score, household income, and interaction terms. Compared with HI-nDTG as the reference group, the HI-DTG group showed a modest but significant greater annual increase in BMI (0.32 kg/m²/year; 95% CI: 0.03-0.62; p = 0.03), with no differences observed for HEU or HUU. Baseline BMI z-score, household income, and female sex were more strongly associated with BMI over time than DTG use. Within the HI-DTG group, a mean annual increase of 0.19 kg/m²/year was observed after switching to DTG.

CONCLUSION

Switching to DTG was associated with an increase in BMI among ALHIV. These findings underscore the need for close metabolic monitoring to prevent long-term cardiometabolic complications.