Blockbuster HIV drug linked to obesity in women

 

The new blockbuster HIV drug called Dolutegravir is facing speed bumps after new studies showed it causes significant weight gain in women.

Further, it does not achieve viral suppression in people who were already having resistance to other HIV drugs.

However, Dolutegravir, also known as DTG, remains the most powerful HIV drug and its combination is recommended as the preferred option for everyone starting treatment by the World Health Organisation.

Kenya introduced the DTG combination pill last year to replace older drugs as the first line of treatment.

Data from two major studies conducted in Kenya,  South Africa and Cameroon show significant weight gain on users.

The first study is the African Cohort Study, which enrolled nearly 2,000 HIV-positive participants between January 2013 and November 2019 at 12 Pepfar-supported clinics in Kenya, Nigeria, Tanzania and Uganda.

People who used Dolutegravir/TDF/Lamivudine combination were 85 per cent more likely to develop overweight or obesity than those taking other non-dolutegravir combinations.

Also, those on DTG regime were 27 per cent more likely to develop hyperglycemia, excess glucose in the blood often associated with diabetes.

The data was presented at the virtual 23rd International AIDS Conference mid this year.

In the South Africa-Cameroon study called Advance, men on DTG combination gained three to five kilogrammes.

Women gained four to eight kilogrammes.

“Weight increases were largely fat rather than lean body mass, and were distributed in the trunk and limbs,” says the study, also presented in the virtual 23rd International Aids Conference.

Separately, a study reported in Nature Communications by the Advance team, shows that people with HIV resistance to drugs such as Efavirenz or Nevirapine, are less likely to achieve viral suppression even when they switch to DTG.

“Further research is needed to find out if there is a resistance mechanism that explains the result or if it is behavioural,” researchers said.

DTG remains the most powerful ARV on the market.

It is more effective, easier to take and has fewer side effects than alternatively prescribed drugs, according to the WHO. It also has a high genetic barrier to developing drug resistance, which is important given the rising trend of resistance to other regimens.

The drug is produced by ViiV Healthcare, a UK-headquartered company solely focused on HIV treatment.

At least 76 per cent of the company is owned by GlaxoSmithKline, 13.5 per cent by Pfizer and 10 per cent by Shionogi of Japan.