Changes in Metabolic Parameters After Switching From Efavirenz to Dolutegravir-Based Regimen: A Cohort Study in Thai People Living With HIV

Abstract

Switching from efavirenz (EFV) to dolutegravir (DTG) is increasingly common due to DTG's superior efficacy and tolerability, yet its metabolic impact in Southeast Asian populations remains unclear. We conducted a single-center retrospective cohort study (January 2019–December 2022) involving adults on EFV-based antiretroviral therapy for at least 6 months before transitioning to DTG. Weight, body mass index, lipid profiles, fasting blood glucose (FBG), renal function, and alanine transaminase (ALT) were measured at baseline, Month 6, and Month 12. Among 493 participants (mean age 47.6 years; 69% female), mean weight increased from 63.8 to 65.6 kg at Month 12 (P < .001). TC, low-density lipoprotein cholesterol (LDL-C), and triglycerides decreased, while high-density lipoprotein cholesterol (HDL-C) declined and FBG modestly improved. Estimated glomerular filtration rate (eGFR) dropped by 25% (P < .001). Higher baseline HDL-C was protective against significant weight gain (OR 0.11 per 10 mg/dL, P = .030). EFV-to-DTG switching leads to weight gain, mixed metabolic effects, and notable eGFR decline, supporting regular monitoring.