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ABSTRACT
Background. Dolutegravir is an HIV drug, which belongs to the class of integrase inhibitors. In June 2018, WHO recommended the usage of this drug as the first line treatment, in combination with Tenofovir and Lamivudine for the treatment of HIV. This drug has shown a better profile with regard to viral suppression, immunological recovery and more important, a great genetic barrier to resistance, unlike Efavirenz. However, recent data show a higher obesity rate among people on Dolutegravir than on Efavirenz. The aim of this study was to characterize obesity in these two groups, and to investigate whether it would be associated with other metabolic complications. Methods. A pilot study was carried out from march 2020 to July 2020 in three hospitals in Cameroon.. The study populations were made up of HIV-positive people who became obese on protocol including Dolutegravir and those on protocol including Efavirenz. We looked for socio-demographic data, risky eating habits and described the glycemic and lipid profiles under these two protocols. The homeostatic model (HOMA-IR) was used to assess insulin sensitivity, with an insulin resistance threshold defined as 2.1 or greater. The measurement of visceral adiposity (v) and subcutaneous adiposity (s) was made using CT scans passing through the navel. a v/s ratio to assess the metabolic risk was determined. The significance threshold was set at 5%. Results. We enrolled 22 participants, in this study. They were 11 for the Dolutegravir and 11 for the Efavirenz. We found a 50 % prevalence of android type obesity among our various participants; it was 87,5 % in the Dolutegravir group, and 40 % in the Efavirenz group p = 0.06 (Table 1). Regarding Insulin resistance, it was present in 22.7 % of our participants, that is 45.5% for the Dolutegravir arm and 0 % for Efavirenz arm p = 0.07 (Table 2); however, we did not observe any case of diabetes nor glucose intolerance for both participants. The study of fat distribution with CT scan showed that adipose tissue was preferentially located in the subcutaneous space. We had a mean of 268.6 cm3 for subcutaneous adiposity, and 97.9 cm3 for visceral adiposity in the Dolutegravir group while in the Efavirenz group, the mean for subcutaneous adiposity was 240.8 cm3 and 75.1 cm3 for visceral adiposity. The estimated metabolic risk ratio (v/s) was 0.42 for all the participants. Conclusion. There is a significant difference between the waist over hip circumference suggesting that obesity under Dolutegravir is of Android type. We found no case of diabetes in our two groups. Insulin resistance is present in 45% of people on Dolutegravir compared to 0% in people on Efavirenz and Fat is more located in the subcutaneous space.
RÉSUMÉ
Background. Dolutegravir is an HIV drug, which belongs to the class of integrase inhibitors. In June 2018, WHO recommended the usage of this drug as the first line treatment, in combination with Tenofovir and Lamivudine for the treatment of HIV. This drug has shown a better profile with regard to viral suppression, immunological recovery and more important, a great genetic barrier to resistance, unlike Efavirenz. However, recent data show a higher obesity rate among people on Dolutegravir than on Efavirenz. The aim of this study was to characterize obesity in these two groups, and to investigate whether it would be associated with other metabolic complications. Methods. A pilot study was carried out from march 2020 to July 2020 in three hospitals in Cameroon.. The study populations were made up of HIV-positive people who became obese on protocol including Dolutegravir and those on protocol including Efavirenz. We looked for socio-demographic data, risky eating habits and described the glycemic and lipid profiles under these two protocols. The homeostatic model (HOMA-IR) was used to assess insulin sensitivity, with an insulin resistance threshold defined as 2.1 or greater. The measurement of visceral adiposity (v) and subcutaneous adiposity (s) was made using CT scans passing through the navel. a v/s ratio to assess the metabolic risk was determined. The significance threshold was set at 5%. Results. We enrolled 22 participants, in this study. They were 11 for the Dolutegravir and 11 for the Efavirenz. We found a 50 % prevalence of android type obesity among our various participants; it was 87,5 % in the Dolutegravir group, and 40 % in the Efavirenz group p = 0.06 (Table 1). Regarding Insulin resistance, it was present in 22.7 % of our participants, that is 45.5% for the Dolutegravir arm and 0 % for Efavirenz arm p = 0.07 (Table 2); however, we did not observe any case of diabetes nor glucose intolerance for both participants. The study of fat distribution with CT scan showed that adipose tissue was preferentially located in the subcutaneous space. We had a mean of 268.6 cm3 for subcutaneous adiposity, and 97.9 cm3 for visceral adiposity in the Dolutegravir group while in the Efavirenz group, the mean for subcutaneous adiposity was 240.8 cm3 and 75.1 cm3 for visceral adiposity. The estimated metabolic risk ratio (v/s) was 0.42 for all the participants. Conclusion. There is a significant difference between the waist over hip circumference suggesting that obesity under Dolutegravir is of Android type. We found no case of diabetes in our two groups. Insulin resistance is present in 45% of people on Dolutegravir compared to 0% in people on Efavirenz and Fat is more located in the subcutaneous space.

Keywords

HIV Dolutegravir Efavirenz Insulin resistance Diabetes Visceral adiposity

Article Details

How to Cite
Kouanfack, C., Mfeukeu, L., Zemsi, S., Etoa, M., Zemsi, A., Mbakop, Y., Lantche, M., Youm, E., Mbanya, J. C., Fouda, P. J., Ongolo Zogo, P., & Sobngwi, E. (2021). Clinical, Biochemical and CT-Scan Characteristics of Obesity Onset in Patients Under Dolutegravir in Comparison With Low-Dose-Efavirenz: A Pilot Study in Cameroon. HEALTH SCIENCES AND DISEASE, 22(3). https://doi.org/10.5281/hsd.v22i3.2562
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