Change in body weight and risk of hypertension after switching from efavirenz to dolutegravir in adults living with HIV: evidence from routine care in Johannesburg, South Africa.
Change in body weight and risk of hypertension after switching from efavirenz to dolutegravir in adults living with HIV: evidence from routine care in Johannesburg, South Africa.
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DOI：
10.1016/j.eclinm.2023.101836
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发表时间：
2023-03
影响因子：
15.1
通讯作者：
Venter, Willem D. F.
中科院分区：
文献类型：
--
作者：
Brennan, Alana T.;Nattey, Cornelius;Kileel, Emma M.;Rosen, Sydney;Maskew, Mhairi;Stokes, Andrew C.;Fox, Matthew P.;Venter, Willem D. F.
整合酶链转移抑制剂（integrase strand transfer inhibitor，DFI）dolutegravir是世界卫生组织指南中推荐的药物，但与体重增加有关。我们评估了南非约翰内斯堡一线抗逆转录病毒治疗（ART）中从依法韦仑转换为度鲁特韦的患者的体重变化。我们对2010年1月至2020年12月期间开始ART的非洲黑人艾滋病毒感染者（≥16岁）进行了一项前瞻性队列研究。患者在性别、年龄、ART治疗月数、首次ART治疗方案、血红蛋白、体重指数（BMI）、血压、病毒载量和CD 4计数方面的倾向评分匹配为1：1（未暴露，即仍使用依法韦仑：暴露，即从依法韦仑转换为度鲁特韦）。我们使用线性回归来评估暴露后12个月从依法韦仑转换为度鲁特韦对体重变化和高血压的影响。我们将794名改用度鲁特韦的患者与794名仍在使用依法韦仑的患者进行了匹配。从随访开始至12个月，暴露患者的平均体重变化（1.78 kg; 95%置信区间（CI）：1.04，2.52 kg）高于未暴露患者。我们还发现，与继续使用依法韦仑的患者相比，使用度鲁特韦的患者发生高血压的风险增加了14.2个百分点（95%CI：10.6，17.7）。在现实世界的人群中，从依法韦仑转换为度鲁特韦后，患者体重增加更多，患高血压的风险高于继续使用依法韦仑的患者。然而，需要更长时间的随访，以确定INSTI相关的体重增加是否与长期非传染性疾病风险的变化相关，或者体重增加是否持续，如临床试验所示。这项研究是在美国人民和总统艾滋病紧急救援计划（PEPFAR）通过美国国际开发署的慷慨支持下，根据合作协议72067419 CA 00004的条款进行的。除了（NIDDK）1 K 01 MH 105320 - 01 A1。
The integrase strand transfer inhibitor (INSTI) dolutegravir is recommended in World Health Organization guidelines, but is associated with weight gain. We evaluated weight change in patients switching from efavirenz to dolutegravir in first-line antiretroviral therapy (ART) in Johannesburg, South Africa. We conducted a prospective cohort study of adults (≥16 years) of black African ancestry with HIV who initiated ART between January 2010–December 2020. Patients were propensity score-matched 1:1 (unexposed i.e. remaining on efavirenz: exposed i.e. switched from efavirenz to dolutegravir) on sex, age, months on ART, first ART regimen, haemoglobin, body mass index (BMI), blood pressure, viral load and CD4 count. We used linear regression to assess the effect of switching from efavirenz to dolutegravir on weight change and hypertension 12 months after exposure. We matched 794 patients switching to dolutegravir to 794 remaining on efavirenz. Exposed patients had a higher mean change in weight (1.78 kg; 95% confidence interval (CI):1.04,2.52 kg) from start of follow-up to 12 months vs. unexposed. We also found a 14.2 percentage point increase (95% CI: 10.6,17.7) in the risk of hypertension in those exposed to dolutegravir vs those that remained on efavirenz. In a real-world population, patients gained more weight and were at higher risk of hypertension after switching from efavirenz to dolutegravir than those remaining on efavirenz. Longer follow-up is needed, however, to determine if INSTI-associated weight gain is associated with changes in non-communicable disease risk over the long-term, or whether weight gain is sustained, as seen in clinical trials. This study has been made possible by the generous support of the American People and the President's Emergency Plan for AIDS Relief (PEPFAR) through the (USAID), under the terms of cooperative agreement cooperative Agreement 72067419CA00004. In addition to the (NIDDK) 1K01MH105320-01A1.
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影响因子：
4.2
作者：
Galdamez, Ronald;Garcia, Jose A.;Masia, Mar
通讯作者：
Masia, Mar
影响因子：
7.7
作者：
Fox, Matthew P.;Maskew, Mhairi;Sanne, Ian M.
通讯作者：
Sanne, Ian M.
影响因子：
6
作者：
Bourgi, Kassem;Jenkins, Cathy A.;Koethe, John R.
通讯作者：
Koethe, John R.
DOI：
10.7326/0003-4819-127-8_part_2-199710151-00064
发表时间：
1997-10-15
影响因子：
39.2
作者：
Rubin, DB
通讯作者：
Rubin, DB
影响因子：
3
作者：
Achhra, A. C.;Mocroft, A.;Law, M. G.
通讯作者：
Law, M. G.