Sorakai Wongpaiboonwatana¹

Background: Integrase inhibitor (INSTI) based antiretroviral therapy is the mainstay for people living with HIV (PLHIV). Due to its favorable efficacy and safety profile, dolutegravir (DTG) is widely used in combination with nucleoside reverse transcriptase inhibitors (NRTIs). TLD, a fixed-dose combination of tenofovir disoproxil fumarate (TDF), lamivudine (3TC), and DTG, is the first-line treatment for PLHIV in Thailand. However, data on metabolic complications from DTG-based regimens in the Thai population have not been thoroughly investigated.

Materials and Methods: A cohort study non-randomized trial was conducted at Buddhachinaraj Hospital, Phitsanulok, Thailand. Data on demographics, baseline antiretroviral regimens, and metabolic profiles such as triglycerides, total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), fasting blood sugar, and aminotransferases, were collected at baseline and six months after switching to a DTG-based regimen in virologically suppressed PLHIV between November 1, 2022 and August 31, 2023. Informed consents were obtained from all participants.

Results: One hundred thirty-eight PLHIV were enrolled, with a majority being men, at 59%, and a median age of 47.5 years (IQR 36.2, 55.1). Median CD4 count was 608 cells/mm³ (IQR 452, 805) and median duration of antiretroviral treatment was 13 years (IQR 8, 18). Underlying conditions included dyslipidemia with 44.2%, hypertension for 29.7%, and type II diabetes for 14.5%. Of the participants, 107 out of 138 (77.5%) were on TDF, 3TC, or emtricitabine (FTC) combined with a non-nucleoside reverse transcriptase inhibitor (NNRTI) such as efavirenz (EFV) or rilpivirine (RPV) as their baseline regimen. After six months, significant changes were observed in median triglycerides, from 138.5 to 97.5 mg/dL (p<0.001), total cholesterol from 201 to 173 mg/dL (p<0.001), and LDL cholesterol from 117 to 103 mg/dL (p<0.001). Median body weight increased from 63.2 to 63.35 kg (p<0.001).

Conclusion: DTG, a second-generation INSTI, is widely used as a key antiretroviral therapy in Thailand. While it demonstrates favorable effects on lipid profiles, body weight gain, which is a crucial factor for cardiovascular outcomes, should be monitored closely.

Received 10 July 2024 | Revised 30 September 2024 | Accepted 9 October 2024

DOI: 10.35755/jmedassocthai.2024.12.1021-1025-01101