Blood pressure, weight change and incident hypertension after switching to dolutegravir in treatment-experienced people with HIV.

OBJECTIVE

Dolutegravir (DTG) is recommended in WHO guidelines and has reportedly been associated with excess gain in body weight (BW).

DESIGN

In the prospective LighTen Cohort Study (ClinicalTrials.gov NCT02381275) we evaluated changes in BW and blood pressure (BP) of people with HIV (PWH) who had initiated tenofovir (TDF)/lamivudine (3TC)/efavirenz (EFV; TLE). Follow-up continued after participants had been switched to TDF/3TC/DTG (TLD) in 2019.

METHODS

From the electronic medical record system, we retrieved data on BW and systolic BP of LighTen Cohort Study participants (age ≥18 years), who were still in care. We modelled BW and systolic BP over time utilizing interrupted time series (ITS) considering repeated measurements and adjusting for age and sex. Incident hypertension was defined as office BP ≥140/90 mmHg using ≥2 measurements on ≥2 consecutive visits.

RESULTS

Data of 543 PWH (317 females) were analysed. ITS showed an increase in BW of 1.24 kg/year on TLE with a minimal contribution (36.5 g/year) during DTG treatment, in contrast to the change in systolic BP: 0.33mmHg/year on TLE vs. 2.63 mmHg/year on DTG. Incident hypertension in previously normotensive PWH was confirmed in 5.4% (while on TLE) vs. 11.0% (while on TLD).

CONCLUSIONS

Following the initial increase in BW on TLE, a larger increase in BP and a higher risk of incident hypertension was associated with switching antiretroviral therapy from TLE to TLD. Focussing on BP control while on DTG and timely initiation of antihypertensive drug therapy can help to reduce the burden of hypertension in PWH with their inherent increased cardiovascular risk.