“It’s only fatness, it doesn’t kill”: a qualitative study on perceptions of weight gain from use of dolutegravir-based regimens in women living with HIV in Uganda

Abstract

Background Dolutegravir (DTG)-based regimens have been recommended by the WHO as the preferred first-line and second-line HIV treatment in all populations. Evidence suggests an association with weight gain, particularly among black women. Our study investigated perceptions of weight gain from DTG-based regimen use on body image and adherence of antiretroviral therapy in women living with HIV (WLHIV) in Uganda. Methods Between April and June 2021, we conducted semi-structured interviews involving 25 WLHIV (adolescents, women of reproductive potential and post-menopausal women) and 19 healthcare professionals (clinicians, nurses, ART managers and counsellors) purposively selected from HIV clinics in Kampala. The interviews explored perceptions of body weight and image; experiences and management of weight related side effects associated with DTG; and knowledge and communication of DTG-related risks. Data was analysed thematically in NVivo 12 software. Results Our findings indicate WLHIV in Uganda commonly disliked thin body size and aspired to gain moderate to high level body weight to improve their body image, social standing and hide their sero-positive status. Both WLHIV and healthcare professionals widely associated weight gain with DTG use, although it was rarely perceived as an adverse event and was unlikely to be reported or to alter medication adherence. Clinical management and pharmacovigilance of DTG-related weight gain were hampered by the limited knowledge of WLHIV of the health risks of being over-weight and obesity; lack of diagnostic equipment and resources; and limited clinical guidance for managing weight gain and associated cardiovascular and metabolic comorbidities. Conclusions The study highlights the significance of large body-size in promoting psychosocial wellbeing in WLHIV in Uganda. Although weight gain is recognized as a side effect of DTG, it may be welcomed by some WLHIV. Healthcare professionals should actively talk about and monitor for weight gain and occurrence of associated comorbidities to facilitate timely interventions. Improved supply of diagnostic equipment and support with sufficient guidance for managing weight gain for healthcare professionals in Uganda are recommended.

Impact of weight gain with dolutegravir on antiretroviral adherence and viral suppression in four African countries

“…Qualitative research among women with HIV in Uganda found that weight gain with TLD was rarely perceived as an adverse event and would be unlikely to alter adherence [17]. Our analysis provides some quantitative support for these observations.…”

Body mass index trends and its impact of under and overweight on outcome among PLHIV on antiretroviral treatment in rural Tanzania: A prospective cohort study

“…Lastly, we did not analyze the impact of different ART regimens on BMI, as almost all patients were on an efavirenz-based first-line regimen. Dolutegravir, which has been reported to be associated with weight gain [15,[44][45][46][47][48], has only relatively recently been rolled out in Tanzania. Future studies are planned to assess the impact of dolutegravir on BMIs in this population and the current study will set a baseline to be compared with the dolutegravir-based ART regimen.…”

HIV-1 Integrase Strand Transfer Inhibitors and Neurodevelopment

“…Moreover, weight gain should be universally reported in association with INSTI use. Weight gain may be under-reported in underdeveloped areas due to positive perceptions of weight gain, leading to inefficient risk communication to HIV patients experiencing unhealthy weight gain [109].…”