What is Dovato?
Dovato is a complete, two-drug, single-tablet regimen for the treatment of HIV-1 infection in adults and adolescents weighing at least 25 kg. It is a combination of two active ingredients:
- Dolutegravir (DTG): An integrase strand transfer inhibitor (INSTI) that works by blocking a viral enzyme, integrase, which is necessary for HIV to replicate.
- Lamivudine (3TC): A nucleoside reverse transcriptase inhibitor (NRTI) that also helps block HIV replication.
The Link Between Dovato and Weight Gain
The association between Dovato and weight gain is mainly linked to its dolutegravir component. Integrase inhibitors, including dolutegravir, have been linked to greater weight gain compared to some older antiretroviral therapies. This is different from the weight gained when someone recovers from HIV-related illness after starting effective treatment. Studies indicate that dolutegravir can lead to significant weight increases and a higher risk of obesity in some individuals.
Potential Mechanisms of Weight Gain
The exact reasons for weight gain with integrase inhibitors are not fully understood, but several theories are being explored:
- Effects on fat cells: Dolutegravir might influence fat cells, potentially increasing fat storage and the creation of new fat cells.
- Removal of weight-suppressive effects: Some older HIV drugs might have suppressed weight. Switching from these to a dolutegravir-based regimen could result in weight gain.
- Influence on appetite: Another theory suggests INSTIs could affect how the brain regulates appetite and food intake.
Clinical Evidence from Key Studies
Clinical trials have examined weight gain with dolutegravir:
- ADVANCE Study: This study found that regimens containing dolutegravir, particularly with tenofovir alafenamide (TAF), were associated with notable weight gain. Even with tenofovir disoproxil fumarate (TDF), dolutegravir showed more weight gain than efavirenz.
- NAMSAL Study: Patients starting dolutegravir gained a median of 5 kg over 96 weeks, more than those on an efavirenz regimen.
- TANGO Trial: In this study of individuals with suppressed viral loads, 3% of those on Dovato experienced weight gain.
Who is at higher risk for weight gain?
Certain groups may be more prone to weight gain on dolutegravir:
- Women: Studies like ADVANCE and NAMSAL showed women gaining significantly more weight than men.
- Black individuals: Some studies have noted a higher risk in people of African descent.
- Lower baseline weight or BMI: Individuals starting treatment with lower body weight or BMI may see greater weight increases.
- Virologically suppressed individuals: Weight gain has also been observed in people who switch to an INSTI-based regimen after achieving viral suppression.
Dovato vs. Biktarvy: A Comparative Look
| Feature | Dovato (Dolutegravir/Lamivudine) | Biktarvy (Bictegravir/Emtricitabine/Tenofovir Alafenamide) |
|---|---|---|
| Drug Class | INSTI and NRTI | INSTI and NRTIs (including TAF) |
| Weight Gain Potential | Associated with weight gain, primarily from the dolutegravir component. | Also associated with weight gain, potentially greater than Dovato due to the combination of an INSTI (bictegravir) and TAF. |
| Clinical Trial Data | The PASO DOBLE trial showed less weight gain with Dovato than with Biktarvy over 48 weeks, particularly when switching from older ARTs. | In the PASO DOBLE trial, patients on Biktarvy experienced significantly more weight gain than those on Dovato. |
| Other Factors | The combination with TAF in other regimens has been shown to contribute significantly to weight gain, making the drug combination important to consider. | TAF is known to be a contributing factor to weight gain when combined with an INSTI. |
Managing Weight While on Dovato
Managing weight on Dovato is important, and you should always work with your healthcare provider. Do not stop your medication without their guidance.
Strategies for weight management include:
- Healthy diet: Focus on nutritious foods like vegetables, lean proteins, and whole grains, while limiting high-sugar and high-fat items. A dietitian can offer personalized advice.
- Regular exercise: Aim for a mix of aerobic activities and strength training. At least 150 minutes of moderate aerobic exercise and two strength training sessions weekly are recommended.
- Weight monitoring: Your healthcare team should regularly monitor your weight and BMI.
- Considering other medications: Discuss potential weight management medications, such as GLP-1 agonists, with your doctor if lifestyle changes are not enough.
Conclusion
Dovato is an effective HIV treatment, but weight gain is a potential side effect linked mainly to dolutegravir. Factors like gender and baseline weight can influence this. This weight gain is different from the "return to health" effect. Weight gain on Dovato is generally manageable. By maintaining a healthy lifestyle and consulting with a healthcare provider, individuals can manage their weight while ensuring their HIV is effectively treated.
