TOPLINE:
Patients who initiated the dolutegravir/abacavir/lamivudine (DTG/ABC/3TC) antiretroviral regimen during acute HIV infection had greater increases in BMI, systolic blood pressure, and cholesterol levels than those who initiated efavirenz/tenofovir disoproxil fumarate/emtricitabine (EFV/TDF/FTC), over nearly 2 years of follow-up.
METHODOLOGY:
- Researchers conducted a retrospective study to evaluate changes in blood pressure and various metabolic parameters among patients with acute HIV infection who initiated either EFV- or DTG-based antiretroviral therapy regimens.
- They analyzed 304 patients (median age, 26 years; 98% men) from the RV254 acute HIV infection cohort, of whom 160 initiated EFV/TDF/FTC and 144 initiated DTG/ABC/3TC.
- From treatment initiation through 96 weeks of follow-up, researchers tracked BMI, systolic and diastolic blood pressure, and lipid profiles (total cholesterol, high-density lipoprotein, and low-density lipoprotein) for all patients.
TAKEAWAY:
- At treatment initiation, both groups had similar HIV viral load-related parameters, diastolic blood pressure, and levels of total cholesterol and low-density lipoprotein; however, the DTG/ABC/3TC group had a higher BMI and lower systolic blood pressure.
- By week 96, 97% of patients on DTG/ABC/3TC achieved viral suppression (HIV RNA < 50 copies per mL) compared with 100% of those on EFV/TDF/FTC (P = .023).
- Over 96 weeks of follow-up, DTG/ABC/3TC initiators had greater median increases in BMI (1.0 vs 0.3; P < .001) and systolic blood pressure (9 mm Hg vs 4 mm Hg; P < .001) than EFV/TDF/FTC initiators.
- The DTG/ABC/3TC group also showed greater median increases in levels of total cholesterol (P = .003) and low-density lipoprotein (P = .023) than the EFV/TDF/FTC group.
IN PRACTICE:
“Clinicians should remain vigilant about long-term body weight and blood cholesterol changes following ART [antiretroviral therapy] initiation, especially in those with pre-existing cardiovascular risk factors,” the authors wrote.
SOURCE:
This study was led by Phillip Chan, Yale School of Medicine, New Haven, Connecticut. It was published online on July 30, 2025, in HIV Medicine.
LIMITATIONS:
These study findings may not be generalizable to other populations, such as women and older adults with HIV infection. The analysis excluded patients who were intolerant to EFV or DTG as well as those who switched from EFV/TDF/FTC to DTG/ABC/3TC before completing 96 weeks. Fasting blood glucose and triglyceride levels and the occurrence of metabolic syndrome were not assessed.
DISCLOSURES:
This study was supported by the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc; National Institute of Allergy and Infectious Diseases; National Institute of Mental Health; and National Institute of Neurological Disorders and Stroke. Two authors reported receiving research grants from the National Institutes of Health and/or National Institute of Mental Health.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.