Is there evidence for immunological alterations with GLP-1 agonists in people living with HIV?

Abstract

category: Co-morbidities Abstract body Purpose: The use of dolutegravir (DTG) has been associated with weight gain and potential risk for hypertension. We evaluated change in blood pressure, weight and other cardiovascular disease risk factors in the Second-line Switch to DTG study (2SD). Method: The 2SD study evaluated the efficacy and safety of switching virally suppressed adults on ritonavir-boosted protease inhibitor (PI/r) based second line regi-men to DTG relative to remaining on a PI/r over 48 weeks. The primary outcomes of this post-hoc analysis were incident hypertension and weight gain. Secondary outcomes included change in systolic and diastolic blood pressure, change in blood sugar, incident diabetes and change in Atherosclerotic Cardiovascular Disease (ASCVD) 10 year risk prediction score. The incidence rate ratio of hypertension was compared between groups and multivariable analysis conducted for predictors 1 of incident hypertension. Results: Data from 795 participants (397 DTG, 398 PI/r) enrolled into the study between Feb and Sep 2020 was analysed. All participants were black and 66% were female, with baseline characteristics balanced between arms. Incident hypertension occurred in 161 participants (86 in the DTG arm and 75 in the PI/r arm) with an incidence rate of 31.4% (33.4% on DTG, 29.3% on PI/r, p = 0.4). Changes in systolic and diastolic BP are highlighted in Figure 1. The percentage change in body mass index (BMI) was 2.1 in the DTG arm and 1.3 in the PI/r arm (p = 0.019) (Figure 2). Incident diabetes occurred in 26 (3.3%) participants (3.5% on DTG, 3.0% on PI/r, p = 0.2). The ASCVD score worsened in 16% of participants (16% on DTG, 15% on PI/r, p = 0.5) (Table 1). Predictors of incident hypertension included age, body mass index and creatinine clearance. Conclusions: DTG was associated with higher weight gain; there was no difference in incident hypertension, blood pressure changes or overall CVD risk stratification between groups.