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

Abstract

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.