Initiation of dolutegravir vs efavirenz on 12- and 24-month weight, body mass index, blood pressure, and incident hypertension: A target trial emulation.

OBJECTIVE

Using the Target Trial Emulation Framework, we evaluated the impact of initiating dolutegravir versus efavirenz on 12- and 24-month weight, body mass index (BMI), blood pressure (BP), and incident hypertension among treatment-naïve individuals in Johannesburg, South Africa from 2019 to 2022.

METHODS

We used linear models to estimate the mean difference in weight, BMI, BP and a log-binomial model to estimate the causal risk difference of incident hypertension, adjusting for patient characteristics via inverse probability weighting.

RESULTS

Among 2930 people initiating treatment from 2019 to 2022, 1847 initiated dolutegravir and 1083 initiated efavirenz. At 12-months, mean difference comparing dolutegravir to efavirenz in weight was 2.9 kg (95% Confidence Interval (CI): -0.3, 5.5), BMI was 0.8 kg/m2 (95% CI: -0.3, 1.9), diastolic BP was 1.6 mmHg (95% CI: -0.7, 3.9) and systolic BP was 3.9 mmHg (95% CI: 1.2, 6.6). Risk of incident hypertension rose by 35% (95% CI: 0.04, 0.5). At 24-months, mean weight difference was 1.9 kg (95% CI: -1.3, 5.1), BMI was 0.6 kg/m2 (95% CI: -0.6, 1.9), diastolic BP was -0.4 mmHg (95% CI: -1.8, 5.1) and systolic BP was 1.7 mmHg (95% CI: -1.8, 5.1). Risk of incident hypertension rose by 22% (95% CI: -0.1, 0.4).

CONCLUSIONS

Dolutegravir was associated with greater increases in weight, systolic BP, and incident hypertension over 24-months, particularly in the first 12-months. Future research is needed to determine whether this reflects a direct effect of dolutegravir or the weight-suppressing effects of efavirenz.