Assessment of weight gain in adult patients living with HIV receiving first‐line dolutegravir‐based or efavirenz‐based ART regimens in routine care clinics in Tshwane district, South Africa: An observational study

Introduction Although dolutegravir (DTG) is deemed stable, safe, cost‐effective, and clinically beneficial, it also carries the risk of side effects, including observed weight gain among patients on DTG‐based antiretroviral therapy (ART) regimens. We compared weight changes among adults (≥18 years) initiating tenofovir disoproxil fumarate, lamivudine, and dolutegravir (TLD) or tenofovir disoproxil fumarate, emtricitabine, and efavirenz (TEE) regimens and those switching from TEE to TLD (TEE‐to‐TLD switchers) in three large primary care facilities in South Africa Methods We conducted a retrospective longitudinal record review using patient medical records, extracting relevant demographic and clinical data from October 2018 to June 2021 from randomly selected adults who initiated TLD or TEE (initiators) and adult TEE‐to‐TLD switchers. We assessed weight, body mass index (BMI), and percentage weight changes for both groups and fitted linear regression and generalized linear models to determine factors associated with weight and BMI change and percentage weight change ≥10%, respectively, among treatment initiators. We fitted linear mixed‐effect models among TEE‐to‐TLD switchers to consider repeated measures. Results Of 860 initiators, 450 (52.3%) initiated on TEE and 410 (47.7%) on TLD, with median follow‐up of 1.4 years and 1.0 year, respectively. At initiation, 43.3% on TEE and 40.8% on TLD were overweight or obese. TLD initiators had an adjusted higher mean weight gain of 1.6 kg (p