Brief Report: Dolutegravir-Based Therapy, Diet, Physical Activity, and Weight Gain: A 48-week Prospective Cohort in South Africa.

BACKGROUND

People with HIV (PWH) have experienced excess weight gain on tenofovir, lamivudine, and dolutegravir (TLD). The contribution of lifestyle behavior to this weight gain is poorly understood.

METHODS

The Population Effectiveness of Dolutegravir Implementation in sub-Saharan Africa (DISCO Study) was a prospective observational cohort study that followed participants in KwaZulu-Natal, South Africa, transitioning to TLD. Our primary outcome of interest was clinically significant weight gain, defined as ≥10% increase from baseline to 48 weeks. Primary exposures of interest were (1) fruit intake (servings/week), (2) vegetable intake (servings/week), (3) fast food intake frequency, (4) fried food intake frequency, (5) sugar-sweetened beverage (SSB) intake frequency, and (6) physical activity (MET-min/week). We compared changes in each exposure for 48 weeks among those with and without clinically significant weight gain and fit logistic regression models to examine adjusted relationships between these exposures and weight gain.

RESULTS

Among 367 participants, the median age was 42 years, 78% were woman, and 18.0% experienced clinically significant weight gain during 48 weeks. The mean change in fruit intake was higher among participants with versus without clinically significant weight gain (0.21 servings/week [95% CI: -0.9 to 1.3] versus -1.07 servings/week [95% CI: -1.5 to -0.6], respectively) ( P = 0.015). However, no significant differences in other behaviors were observed and no dietary and activity behaviors correlated with weight change in multivariable regression models.

DISCUSSION: Weight gain in people transitioning to TLD was not strongly linked to lifestyle. Interventions targeting diet and exercise may be unlikely to mitigate weight gain in this population.