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For Women With HIV, Dolutegravir Associated With Higher Postpartum Weight Over Efavirenz

Women living with HIV who are on an antiretroviral therapy regimen of dolutegravir experienced persistently higher weight postpartum compared with women on efavirenz in Botswana.

Women living with HIV (WHIV) who are on an antiretroviral therapy (ART) regimen of dolutegravir (DTG) experienced persistently higher weight postpartum compared with women on efavirenz (EFV) in Botswana, but their weight was similar to that of HIV-negative (HIV-) women.

Antiretroviral therapy- (ART) associated weight gain has the potential to increase cardiometabolic risk, especially in postpartum women. As more and more data about the metabolic effects of DTG came out, investigators on a large cohort study originally funded to examine metabolic effects of HIV and ART realized there was an opportunity to examine postpartum weight over time. The results were presented at the Annual Conference on Retroviruses and Opportunistic Infections (CROI 2020).

Women enrolled in the Tshilo Dikotla study were pregnant HIV- women and WHIV on either tenofovir (TDF)/emtricitabine or lamivudine (XTC)/DTG or TDF/XTC/EFV initiated during or before pregnancy. Weight measurements were collected 1 to 18 months postpartum, and investigators relied on mixed models to assess the association between HIV/ART status and postpartum weight over time.

The research team also performed subgroup analysis to drill down further on the association between DTG vs EFV and postpartum weight.

A total of 406 women were included in the analysis (170 DTG, 114 EFV). Compared with HIV- women, the women on DTG or EFV were older (median age 28 vs 33 vs 25 years respectively, p<0.01). HIV- women experienced the highest average weight gain per week between the 2nd and 3rd trimester (0.3 vs 0.2 for DTG vs 0.1 kg/week for EFV, p<0.01), as well as the highest breastfeeding duration (35.7 vs. 19.0 for DTG vs. 22.6 weeks for EFV, p<0.01).

No differences in CD4 or log viral load at enrollment were discerned between ART groups. Investigators noted similar postpartum weight through 18 months in WHIV on DTG compared with HIV- women. After adjusting for age, gestational diabetes, breastfeeding duration, and weight gain between 2nd and 3rd trimester, the WHIV on DTG were on average 5 kg heavier postpartum than WHIV on EFV (β=5.0, p<0.01) ><0.01).

“We didn't see huge differences in postpartum weight between women taking DTG and then HIV-uninfected pregnant women postpartum,” Jennifer Jao, MD, MPH, associate professor of pediatrics (infectious diseases), at Northwestern's Feinberg School of Medicine, and presenting author of the study, told Contagion®.

“Although the women on DTG did have higher postpartum weight retention, [it] didn't look to be statistically different,” she continued. “However, when we analyzed just the subgroup of women living with HIV, and we compare DTG to EFV, the women receiving DTG in the first 18 months postpartum had significantly higher postpartum weight over time.”

In conclusion, investigators determined that further studies will be needed to assess the mechanisms of postpartum weight retention.

The poster, “Dolutegravir use is associated with higher postpartum weight compared to efavirenz,” was virtually presented Monday, March 9, 2020, at CROI 2020.