Decreased Hepatic Steatosis in South African Adolescents With Perinatal HIV Switching to Dolutegravir-containing Regimens
- 14 March 2023
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in The Pediatric Infectious Disease Journal
- Vol. 42 (7), 564-572
- https://doi.org/10.1097/inf.0000000000003904
Abstract
Background: Although dolutegravir (DTG) has a favorable metabolic profile, it has been linked to excess weight gain. We evaluated changes in hepatic steatosis in adolescents with perinatally acquired HIV switching to DTG-containing antiretroviral therapy (ART). Methods: Virologically suppressed adolescents switched to dolutegravir for a minimum of 4 months or on unchanged ART (84% protease inhibitor) were assessed prospectively with anthropometry, transient elastography with controlled attenuation parameter (CAP) and fasting metabolic profiles. ART regimens were determined independently of the study. Results: In total 68 adolescents [baseline median age 13.5 years [interquartile range (IQR): 12.5–14.4 years]; 42 (62%) female] were recruited. However, 38 remained on the same regimen and were followed for a median of 98 weeks (IQR: 48–108 weeks), and 30 switched to DTG and were followed for a median of 52 weeks (IQR: 49–101). There was no baseline difference in CAP between groups. There was no significant change in body mass index z-score in either group, but the median CAP in the DTG group decreased by −40dB/m (IQR: −51 to −31 dB/m) after a median of 44 weeks (IQR: 28–50 weeks) on DTG, compared to +1dB/m (IQR: −29 to +14 dB/m) in adolescents not switched (P < 0.01). Cholesterol and triglycerides were lower in those switched. Whereas hepatic steatosis prevalence decreased from 17% to 3% in adolescents who switched to dolutegravir, its prevalence doubled from 8% to 16% in those not switched (P = 0.1). Conclusions: In this exploratory study, adolescents switched to DTG-containing regimens had reduced hepatic steatosis, cholesterol and triglycerides with no excess weight gain compared to those on unchanged ART.Keywords
This publication has 50 references indexed in Scilit:
- A 360-degree overview of paediatric NAFLD: Recent insightsJournal of Hepatology, 2013
- Diagnosis of Nonalcoholic Fatty Liver Disease in Children and AdolescentsJournal of Pediatric Gastroenterology and Nutrition, 2012
- The controlled attenuation parameter (CAP): A novel tool for the non-invasive evaluation of steatosis using Fibroscan®Clinics and Research in Hepatology and Gastroenterology, 2012
- Feasibility study and control values of transient elastography in healthy childrenEuropean Journal of Pediatrics, 2011
- Antiretroviral Treatment for Children with Peripartum Nevirapine ExposureThe New England Journal of Medicine, 2010
- Prevalence and risk factors for significant liver fibrosis among HIV-monoinfected patientsBMC Infectious Diseases, 2010
- SAFETY Study: Alanine Aminotransferase Cutoff Values Are Set Too High for Reliable Detection of Pediatric Chronic Liver DiseaseGastroenterology, 2010
- Noninvasive Procedures to Evaluate Liver Involvement in HIV‐1 Vertically Infected ChildrenJournal of Pediatric Gastroenterology and Nutrition, 2009
- Early Antiretroviral Therapy and Mortality among HIV-Infected InfantsThe New England Journal of Medicine, 2008
- Development of a WHO growth reference for school-aged children and adolescentsBulletin of the World Health Organization, 2007