Page 14 - Nursing Matters June 2021 Vol 12

Dolutegravir and weight gain

B Bosch, MBChB
E Bhaskar, MBChB
Ezintsha, a sub-division of Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg

Introduction integrase which in turn prevents HIV In 2019, the South African National
viral material from being merged with Department of Health published updated
South Africa, home to one of the largest the DNA of the patient’s cells. Other ART clinical guidelines, including DTG
3,4
populations of people living with HIV drugs in this class include cabotegravir, as an option for first, second and third-
(PLWH) is also no stranger to continuously bictegravir, elvitegravir and raltegravir line ARV regimens. The primary goals
rising obesity figures – two seemingly (RAL). Of these, only DTG and RAL of ART continue to place emphasis on
unrelated health concerns now closely are available in public healthcare the reduction of HIV-related conditions
intertwined. The introduction of newer programmes in South Africa and DTG is (this including opportunistic infections
1
antiretroviral (ARV) agents over the last preferred for several reasons including such as tuberculosis (TB), minimise the
decade has brought with it significant a higher barrier to developing drug development of resistance to ARVs and
concerns around associated weight gain resistance, the option for once daily improve patients’ quality of life. DTG, in
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and the long-term consequences thereof, dosing and widespread availability in a many ways, satisfies the above criteria,
particularly since PLWH are living longer fixed dose combination. offering rapid viral suppression, a high
and experiencing a higher burden of genetic barrier to the development of
non-communicable diseases (NCDs) resistance and proving more tolerable
2
than ever before. In South Africa, the Dolutegravir has proven beneficial than EFV, a drug dominating first-line
rollout of dolutegravir (DTG) into state in multiple randomised control trials, ART in South Africa for many years.
programmes and ongoing data from justifying its use in PLWH who are
recent clinical trials has highlighted this, both antiretroviral therapy (ART) naïve As a drug class, the side effects
raising fears around the suitability of and experienced. These include trials associated with InSTI use are mild,
5,6,
DTG in our population. comparing DTG to efavirenz (EFV) largely self-limiting and rarely lead
7
8
RAL , darunavir and ritonavir-boosted to treatment discontinuation. These
9
Dolutegravir and weight gain atazanavir , as well as several treatment commonly include neuropsychiatric
switch-studies in patients failing first-line symptoms such as insomnia, abnormal
Dolutegravir is part of an ARV drug class ART. 10–12 Additionally, clinical trials are dreams, headaches and dizziness.
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known as integrase strand inhibitors underway using DTG in a two-drug InSTI-related weight gain, however, was
(InSTI), which prevent viral replication treatment regimen in efforts to decrease first noted in mid-2018 and thought to
through blocking of the viral enzyme long-term drug exposure and toxicity. 13 be a drug class side effect. As evidence

HIV Nursing Matters | June 2021 | page 12