The observed weight gain is different from the weight people normally add as they return to good health following treatment.
An analysis of people living with HIV from 2013 to 2020 shows those on the three-drug combo tenofovir/lamivudine/dolutegravir (TLD) gain an average of three kilos in the first year.
The weight gain consists mostly of unhealthy fat rather than lean muscle mass and is primarily distributed in the torso and limbs.
It is blamed on the dolutegravir drug, because patients who took other drug combinations did not become as fat.
The findings have caused concern, with medics being advised to be cautious when prescribing dolutegravir because obesity increases the risk of other chronic diseases.
“Elevated BMI and weight gain among people living with HIV on TLD are concerning safety signals,” researchers said.
“Morbidity linked to Dolutegravir will need to be further investigated, particularly in older age groups at risk for multiple NCDs.”
The findings are published in the Journal of the International Aids Society, under the title, "Weight gain during the dolutegravir transition in the African Cohort Study."
The results align with similar evidence from other countries. This is discouraging because dolutegravir (also called DTG), is the most powerful ARV on the market.
Kenya became the first country in Africa to adopt a generic version of DTG in 2017.
The drug was later made the first-line treatment for HIV because it has few side effects and is more potent, which means fewer people will need to switch to more costly second-line treatments.
US’s Pepfar also committed to supporting the countries it funds, including Kenya to transition to the single-tablet of TLD in 2019.
The study, called the African Cohort Study (AFRICOS), followed adults with and without HIV in Kenya, Uganda, Tanzania and Nigeria.
About 2,950 PLWH were enrolled and 1,474 transitioned to TLD.
Those on TLD gained more weight than other patients in the first year, an average of three kilos.
The researchers recommend monitoring users for continued weight gain beyond the first two years after TLD switch, which could predispose them to potential downstream metabolic effects.
“These potential risks associated with weight gain should be weighed against the demonstrated superiority of INSTI‐based regimens in achieving viral suppression,” they said.
About 1.5 million Kenyans are living with HIV and one million of them are on treatment, says the National Aids Control Council.
The treatment is mainly funded by Pepfar and the Global Fund.
Last month, several health lobbies called on the next government to ensure that taxes on all health commodities especially TB, Malaria and HIV drugs are zero-rated.
The lobbies further demanded that investments in health be increased to ensure the country moves towards self-sustainability amid reducing funding from donors.
The lobbies included AIDS Healthcare Foundation Kenya, Stop TB Partnership Kenya.
The National Empowerment Network of People Living with HIV and AIDS in Kenya (NEPHAK) and the Coalition for Health Research and Development (CHReaD).
Others are Concern Worldwide, Lean on Me and Ambassador for Youth and Adolescent Rep Health Programme (AYARHEP).
(Edited by Tabnacha O)
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