Blood pressure and metabolic outcomes after efavirenz- or dolutegravir-based therapy started in acute HIV infection.

OBJECTIVE

This retrospective study compared changes in body mass index (BMI), systolic and diastolic blood pressure (SBP and DBP) and lipid profile at 96 weeks following initiation of efavirenz/tenofovir disoproxil fumarate/emtricitabine (EFV/TDF/FTC) or dolutegravir/abacavir/lamivudine (DTG/ABC/3TC), two frequently used antiretroviral therapy (ART) regimens in prior and current World Health Organization (WHO) ART guidelines during acute HIV infection (AHI).

METHODS

Participants included 304 Thai RV254 AHI cohort participants (mean age 28, 98% male); 160 (53%) initiated EFV/TDF/FTC and 144 (47%) DTG/ABC/3TC during AHI. All maintained their ART regimens for 96 weeks, with assessments at weeks 0, 24, 48, 72 and 96. Longitudinal changes were compared using linear mixed models.

RESULTS

At week 0, the two groups were similar in age, sex, levels of plasma HIV RNA, CD4+ and CD8+ T-cell counts and CD4/CD8 ratios, along with levels of total cholesterol (TC), low-density lipoprotein (LDL) and DBP. However, DTG/ABC/3TC users had higher BMI and lower SBP than EFV/TDF/FTC users (p < 0.05). After 96 weeks, DTG/ABC/3TC users demonstrated greater increases in BMI, SBP, TC and LDL than EFV/TDF/FTC users in unadjusted and adjusted models corrected for age, sex and Fiebig staging (p < 0.05), while their changes in DBP and high-density lipoprotein did not differ.

CONCLUSIONS

In these young men initiating ART during AHI, DTG/ABC/3TC users exhibited greater increases in BMI, SBP, TC and LDL than EFV/TDF/FTC users by week 96. In addition to body weight changes, clinicians should remain vigilant regarding blood pressure and cholesterol changes following ART initiation, especially in those with pre-existing cardiovascular risk factors.