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reduces the glycaemic index of Additionally, the use of technology 44. Available from: https://cjasn.asnjournals.org/lookup/
doi/10.2215/CJN.02240218
this carbohydrate dense food, such as smartphone applications can 4. Bardal SK, Waechter JE, Martin DS. Infectious Diseases
preventing an insulin spike which assist in learning about foods and their [Internet]. In: Applied Pharmacology. Elsevier; 2011. p. 233–91.
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reduces its fat storing function. 22 components, especially when engaging 5. Walmsley SL, Antela A, Clumeck N, et al. Dolutegravir plus
6. Patients should be encouraged to the youth. 24 Abacavir–Lamivudine for the Treatment of HIV-1 Infection. N
Engl J Med [Internet] 2013;369(19):1807–18. Available from:
practice moderation in their diets so http://www.nejm.org/doi/10.1056/NEJMoa1215541
as to make long term improvements Conclusion 6. Venter WDF, Moorhouse M, Sokhela S, et al. Dolutegravir plus
Two Different Prodrugs of Tenofovir to Treat HIV. N Engl J Med
[Internet] 2019;381(9):803–15. Available from: http://www.
in eating patterns. nejm.org/doi/10.1056/NEJMoa1902824
7. Understanding the importance So, what are our options? EFV, despite 7. Stellbrink H-J, Reynes J, Lazzarin A, et al. Dolutegravir
in antiretroviral-naive adults with HIV-1. AIDS [Internet]
of choosing foods with a low poor tolerability when compared 2013;27(11):1771–8. Available from: http://journals.lww.
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glycaemic index (the measure of to newer ARVs, has typically been 8. Molina J-M, Clotet B, van Lunzen J, et al. Once-daily dolutegravir
versus darunavir plus ritonavir for treatment-naive adults
which glucose is released into the associated with equal effectivity and with HIV-1 infection (FLAMINGO): 96 week results from a
randomised, open-label, phase 3b study. Lancet HIV [Internet]
blood stream after it is digested) can does not have associated weight gain. 2015;2(4):e127–36. Available from: https://linkinghub.
elsevier.com/retrieve/pii/S2352301815000272
help patients consume foods that are Newer agents such as doravirine, 9. Orrell C, Hagins DP, Belonosova E, et al. Fixed-dose combination
dolutegravir, abacavir, and lamivudine versus ritonavir-boosted
higher in fibre, micronutrients and islatravir and cabotegravir which atazanavir plus tenofovir disoproxil fumarate and emtricitabine
in previously untreated women with HIV-1 infection (ARIA): week
antioxidants as well as choosing although not yet registered for use, may 48 results from a randomised, open-label. Lancet HIV [Internet]
2017;4(12):e536–46. Available from: https://linkinghub.
foods lower in calories. 22 offer future alternatives. elsevier.com/retrieve/pii/S2352301817300954
8. Patients should incorporate exercise 10. Aboud M, Kaplan R, Lombaard J, et al. Dolutegravir versus
ritonavir-boosted lopinavir both with dual nucleoside reverse
transcriptase inhibitor therapy in adults with HIV-1 infection
into their weekly routines in a way At present there is no evidence to in whom first-line therapy has failed (DAWNING): an open-
label, non-inferiority, phase 3b trial. Lancet Infect Dis [Internet]
that is safe but effective. This may support the reversal of weight gain after 2019;19(3):253–64. Available from: https://linkinghub.
elsevier.com/retrieve/pii/S1473309919300362
include walking instead of catching ART switching and as such defining 11. Trottier B, Lake JE, Logue K, et al. Dolutegravir/abacavir/
clear guidelines for switching ARVs is
public transport, joining community lamivudine versus current ART in virally suppressed patients
(STRIIVING): a 48-week, randomized, non-inferiority, open-
exercise programmes, or committing difficult and should largely be patient label, Phase IIIb study. Antivir Ther [Internet] 2017;22(4):295–
305. Available from: https://www.intmedpress.com/journals/
tailored until more concrete evidence
avt/abstract.cfm?id=3166&pid=48
to at-home guided training. Research exists. Our recommendations would 12. van Wyk J, Ajana F, Bisshop F, et al. Efficacy and Safety of
continues to support the conclusion be to consider a switch from DTG Switching to Dolutegravir/Lamivudine Fixed-Dose 2-Drug
Regimen vs Continuing a Tenofovir Alafenamide–Based 3- or
that physical activity accumulated should patients develop new metabolic 4-Drug Regimen for Maintenance of Virologic Suppression in
Adults Living With Human Immunodeficiency Virus Type 1: Phas.
in bouts of at least 10 minutes can consequences (such as diabetes mellitus, Clin Infect Dis [Internet] 2020;71(8):1920–9. Available from:
https://academic.oup.com/cid/article/71/8/1920/5697294
improve a variety of health-related hypertension and dyslipidaemia) 13. Cahn P, Madero JS, Arribas JR, et al. Dolutegravir plus
lamivudine versus dolutegravir plus tenofovir disoproxil fumarate
outcomes. 23,24 along with a significant increase in and emtricitabine in antiretroviral-naive adults with HIV-1
infection (GEMINI-1 and GEMINI-2): week 48 results from
weight. Cultural sensitivity and allowing two multicentre, double-blind, randomised, non-inferior. Lancet
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In addition, healthcare practitioners are patients autonomy when considering 14. Republic of South Africa National Department of Health. 2019
encouraged to perform the following at approaches to weight gain is vital – ART Clinical Guidelines for the Management of HIV in Adults,
Pregnancy, Adolescents, Children, Infants and Neonates
each visit to aid in assessment of patients’ not only does being underweight often [Internet]. [cited 2020 Nov 11];Available from: https://sahivsoc.
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cardiovascular risk: attract stigma of HIV and TB infection, 15. Kolakowska A, Maresca AF, Collins IJ, Cailhol J. Update on
• Anthropometric measurements: but the reverse denotes wealth and Adverse Effects of HIV Integrase Inhibitors. Curr Treat Options
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weight, height, BMI, waist status in many cultures. Whilst clinical 16. Venter WDF, Sokhela S, Simmons B, et al. Dolutegravir with
circumference discretion is advised where clear harm emtricitabine and tenofovir alafenamide or tenofovir disoproxil
fumarate versus efavirenz, emtricitabine, and tenofovir disoproxil
• Body composition measurements: over benefit for the patient exists (e.g. fumarate for initial treatment of HIV-1 infection (ADVANCE):
week 96 results from a randomised, phase 3, n. Lancet HIV
waist-to-hip ratios, skinfold weight gain with resultant development [Internet] 2020;7(10):e666–76. Available from: https://
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measurements of metabolic consequences), patients 17. (WHO) WHO. Global Action Plan for the Prevention and
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• Biochemical markers: fasting blood should be allowed the opportunity to 18. HIV Glasgow – Virtual, 5–8 October 2020. J Int AIDS Soc
glucose, HbA1c, lipogram make informed decisions around their [Internet] 2020;23(S7). Available from: https://onlinelibrary.
wiley.com/doi/10.1002/jia2.25616
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and Opportunistic Infections [Internet]. 2020. Available from:
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20. United States Department of Agriculture. Choose My Plate
[Internet]. [cited 2020 Nov 25];Available from: https://www.
Governments have a central role in choosemyplate.gov/
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