Body Mass Index Trends in Children and Adolescents on Antiretroviral Therapy in Nigeria: A Prospective Evaluation of Regimen-Specific Effects

Oluwaseyi Bamisaye; Ewean Chukwuma Omoruyi; Ifedolapo Damilola Ayodele; Olalekan Lateef Samuel; Bukola Bridgette Johnson

doi:10.51152/jbarbiomed.v11i1.247

Authors

Dr. Bamisaye Department of Biomedical Laboratory Science, College of Medicine, University of Ibadan
Ewean Chukwuma Omoruyi Clinical Virology Laboratory, College of Medicine, University of Ibadan
Ifedolapo Damilola Ayodele University of Ibadan
Olalekan Lateef Samuel Infectious Disease Institute, College of Medicine, University of Ibadan
Bukola Bridgette Johnson Mid and South Essex, NHS Foundation Trust

DOI:

https://doi.org/10.51152/jbarbiomed.v11i1.247

Keywords:

Antiretroviral therapy, Weight gain, Adolescents living with HIV, Dolutegravir

Abstract

Children and adolescents living with Human Immunodeficiency Virus (CALHIV) on antiretroviral therapy (ART) are susceptible to metabolic changes as they develop into adulthood, including significant variations in body mass index (BMI). This study evaluates the relationship between ART regimens and BMI trends in a cohort of paediatric population, exploring demographic influences and regimen-specific outcomes. This prospective observational study analyzed BMI trends in 147 children and adolescent living with HIV (CALHIV) (aged 2-16 years) on various ART regimens across three clinic visits. Participants were grouped into six ART regimen categories, including DTG- and LPV/r-based therapies. BMI (calculated from weight and height), CD4 counts, and viral load data were collected and analyzed to assess changes over time in each clinic visit. The data obtained were analyzed using SPSS version 20, with descriptive statistics and BMI changes assessed across visits; significance was set at p < 0.05. The mean participant age was 10.87±3.64 years, with most (95) aged ≥10 years and a male predominance (85 males, 62 females). BMI increased across all groups, with the TLD regimen showing the highest increase (22.99±3.45, 24.94±4.20, 26.79±4.97; p<0.05). BMI increases were progressive across the 3 visits in the TLD group with a consistent >85^th percentile CDC BMI category. Adolescents (mean age: 13 years) had higher BMI, while gender had no significant impact (p=0.48). Despite BMI increases, CD4+ counts remained stable, and viral load was notably higher in ALD and ALE groups, though not statistically significant (p>0.05). Dolutegravir-based ART regimens, particularly TLD, are linked to significant BMI increases while maintaining virological while maintaining immunological stability, with variable viral load outcomes. Routine metabolic monitoring and targeted interventions are essential, especially for adolescents. Future studies should explore long-term metabolic outcomes and ART optimization in pediatric populations.

Author Biography

Dr. Bamisaye, Department of Biomedical Laboratory Science, College of Medicine, University of Ibadan

Senior Lecturer and Consultant, Haematology and Blood Transfusion Division, Department of Biomedical Laboratory Science, College of Medicine, University of Ibadan

References

Awodele, O., Aliu, R., Ali, I., Oni, Y. and Adeyeye, C. M. (2018). Patterns of adverse drug reaction signals in NAFDAC pharmacovigilance activities from January to June 2015: Safety of drug use in Nigeria. Pharmacology Research & Perspectives, 6(5), e00427. https://doi.org/10.1002/prp2.427

Bailin, S. S., Gabriel, C. L., Wanjalla, C. N. and Koethe, J. R. (2020). Obesity and weight gain in persons with HIV. Current HIV/AIDS Reports, 17, 138–150. https://doi.org/10.1007/s11904-020-00483-5

Bourgi, K., Ofner, S., Musick, B., Griffith, B., Diero, L., Wools-Kaloustian, K., Yiannoutsos, C. T. and Gupta, S. K. (2022). Weight gain among treatment-naïve persons with HIV receiving dolutegravir in Kenya. Journal of Acquired Immune Deficiency Syndromes, 91(5), 490-496. https://doi.org/10.1097/QAI.0000000000003087

Burt Solorzano, C. M. and McCartney, C. R. (2010). Obesity and the pubertal transition in girls and boys. Reproduction (Cambridge, England), 140(3), 399–410. https://doi.org/10.1530/REP-10-0119

Centre for Disease Control and Prevention. (2022). Body Mass Index (BMI): Childand TeeN BMI Categories. https://www.cdc.gov/bmi/child-teen-calculator/bmi-categories.html.

Dupont, E. and Yombi, J. C. (2023). Antiretroviral therapy and weight gain in antiretroviral treatment-experienced HIV patients: A review. AIDS Reviews, 25(1), 54–64. https://doi.org/10.24875/AIDSRev.22000026

Esber, A. L., Chang, D., Iroezindu, M., Bahemana, E., Kibuuka, H., Owuoth, J., Singoei, V., Maswai, J., Dear, N. F., Crowell, T. A., Polyak, C. S., Ake, J. A., & AFRICOS Study Group. (2022). Weight gain during the dolutegravir transition in the African Cohort Study. Journal of the International AIDS Society, 25, e25899. https://doi.org/10.1002/jia2.25899

Gautron, L., Elmquist, J. K. and Williams, K. W. (2015). Neural control of energy balance: translating circuits to therapies. Cell, 161(1), 133–145. https://doi.org/10.1016/j.cell.2015.02.023

Jiamsakul, A., Kariminia, A., Althoff, K. N., Cesar, C., Cortes, C. P., Davies, M. A., Do, V. C., Eley, B., Gill, J., Kumarasamy, N., Machado, D. M., Moore, R., Prozesky, H., Zaniewski, E. and Law, M. (2017). HIV viral load suppression in adults and children receiving antiretroviral therapy: Results from the IeDEA collaboration. Journal of Acquired Immune Deficiency Syndromes (1999), 76(3), 319–329. https://doi.org/10.1097/QAI.0000000000001499

Karim, S. S. and Baxter, C. (2019). HIV incidence rates in adolescent girls and young women in sub-Saharan Africa. The Lancet Global Health, 7(11), e1470–e1471. https://doi.org/10.1016/S2214-109X(19)30357-7

Kausar, S., Said Khan, F., Ishaq, Mujeeb Ur Rehman, M., Akram, M., Riaz, M., Rasool, G., Hamid Khan, A., Saleem, I., Shamim, S. and Malik, A. (2021). A review: Mechanism of action of antiviral drugs. International Journal of Immunopathology and Pharmacology, 35, 20587384211002621. https://doi.org/10.1177/20587384211002621

Kemnic, T. R. and Gulick, P. G. (2022). HIV antiretroviral therapy. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513308/

Kolakowska, A., Maresca, A. F., Collins, I. J. and Cailhol, J. (2019). Update on adverse effects of HIV integrase inhibitors. Current Treatment Options in Infectious Diseases, 11(4), 372–387. https://doi.org/10.1007/s40506-019-00203-7

Lam, J. O., Leyden, W. A., Alexeeff, S., Lea, A. N., Hechter, R. C., Hu, H., Marcus, J. L., Pitts, L., Yuan, Q., Towner, W. J., Horberg, M. A. and Silverberg, M. J. (2024). Changes in body mass index over time in people with and without HIV infection. Open Forum Infectious Diseases, 11(2), ofad611. https://doi.org/10.1093/ofid/ofad611

Lockman, S., Brummel, S. S., Ziemba, L., Stranix-Chibanda, L., McCarthy, K., Coletti, A., Jean-Philippe, P., Johnston, B., Krotje, C., Fairlie, L., Hoffman, R. M., Sax, P. E., Moyo, S., Chakhtoura, N., Stringer, J. S., Masheto, G., Korutaro, V., Cassim, H., Mmbaga, B. T., João, E., Hanley, S., Purdue, L., Holmes, L. B., Momper, J. D., Shapiro, R. L., Thoofer, N. K., Rooney, J. F., Frenkel, L. M., Amico, K. R., Chinula, L., and Currier, J. (2021). Efficacy and safety of dolutegravir with emtricitabine and tenofovir alafenamide fumarate or tenofovir disoproxil fumarate, and efavirenz, emtricitabine, and tenofovir disoproxil fumarate HIV antiretroviral therapy regimens started in pregnancy (IMPAACT 2010/VESTED): A multicentre, open-label, randomised, controlled, phase 3 trial. The Lancet, 397(10281), 1276–1292. https://doi.org/10.1016/S0140-6736(21)00341-7

Mageda, K., Kulemba, K., Olomi, W., Kapologwe, N., Katalambula, L. and Petrucka, P. (2023). Determinants of nonsuppression of HIV viral load among children receiving antiretroviral therapy in the Simiyu region: a cross-sectional study. AIDS research and therapy, 20(1), 22. https://doi.org/10.1186/s12981-023-00515-1

Marcus, C., Danielsson, P. and Hagman, E. (2022). Pediatric obesity: Long-term consequences and effect of weight loss. Journal of Internal Medicine, 292(6), 870-891. https://doi.org/10.1111/joim.13547.

Dirajlal-Fargo S, McComsey G. A. (2021) Cardiometabolic Complications in Youth with Perinatally Acquired HIV in the Era of Antiretroviral Therapy. Current HIV/AIDS Reports. 18(5):424-435. doi: 10.1007/s11904-021-00574-x.

Matza, L. S., Chung, K. C., Kim, K. J., Paulus, T. M., Davies, E. W., Stewart, K. D., McComsey, G. A. and Fordyce, M. W. (2017). Risks associated with antiretroviral treatment for human immunodeficiency virus (HIV): Qualitative analysis of social media data and health state utility valuation. Quality of Life Research, 26(7), 1785–1798. https://doi.org/10.1007/s11136-017-1519-3.

Natukunda E, Szubert A, Otike C, Namyalo I, Nambi E, Bamford A, Katja Doerholt, Diana M. Gibb, Victor Musiime, Phillipa Musoke. (2023). Bone mineral density among children living with HIV failing first-line anti-retroviral therapy in Uganda: A sub-study of the CHAPAS-4 trial. PLoS ONE 18(7): e0288877. https://doi.org/10.1371/journal.pone.0288877

Norwood, J., Turner, M. and Bofill, C. (2018). Weight gain in persons with HIV switched from efavirenz-based to integrase strand transfer inhibitor-based regimens. Clinical Infectious Diseases, 10. https://doi.org/10.1093/cid/ciz999

Oreagba, I. A., Usman, S. O., Olayemi, S. O., Oshikoya, K. A., Opanuga, O., Adeyemo, T. A., Lesi, O. A., Dodoo, A. N. and Akanmu, A. S. (2014). Pharmacoepidemiology of antiretroviral drugs in a teaching hospital in Lagos, Nigeria. Ghana Medical Journal, 48(4), 194–203. https://doi.org/10.4314/gmj.v48i4.5

Palella, F. J., Hou, Q., Li, J., Mahnken, J., Carlson, K. J., Durham, M., Ward, D., Fuhrer, J., Tedaldi, E., Novak, R. and Buchacz, K. (2023). Weight gain and metabolic effects in persons with HIV who switch to ART regimens containing integrase inhibitors or tenofovir alafenamide. Journal of Acquired Immune Deficiency Syndromes (1999), 92(1), 67–75. https://doi.org/10.1097/QAI.0000000000003101

Patel, F. and Kennedy, C. (2021). Metabolic changes in pediatric HIV-positive patients and potential lifestyle interventional strategies. Cureus, 13(4), e14556. https://doi.org/10.7759/cureus.14556

Rosenberg, N. E., Shook-Sa, B. E., Liu, M., Stranix-Chibanda, L., Yotebieng, M., Sam-Agudu, N. A., Hudgens, M. G., Phiri, S. J., Mutale, W., Bekker, L. G., Moyo, S., Zuma, K., Charurat, M. E., Justman, J. and Chi, B. H. (2023). Adult HIV-1 incidence across 15 high-burden countries in sub-Saharan Africa from 2015 to 2019: A pooled analysis of nationally representative data. The Lancet HIV, 10(3), e175–e185. https://doi.org/10.1016/S2352-3018(22)00328-9

Sawry, S., Ayalew, K., Maimela, G., Briggs-Hagen, M., van Wyk-Heath, M., Mthethwa, S., Shai, S., Mngomezulu, N. N., Tlhowe, L., Achere-Darko, J., Bedford, J., Martin, C. E., Fairlie, L. and Imrie, J. (2024). Assessment of weight gain in adult patients living with HIV receiving first-line dolutegravir-based or efavirenz-based ART regimens in routine care clinics in Tshwane district, South Africa: An observational study. HIV Medicine, 25(7), 826–839. https://doi.org/10.1111/hiv.13638

Sax, P. E., Erlandson, K. M., Lake, J. E., Mccomsey, G. A., Orkin, C., Esser, S., Brown, T. T., Rockstroh, J. K., Wei, X., Carter, C. C., Zhong, L., Brainard, D. M., Melbourne, K., Das, M., Stellbrink, H. J., Post, F. A., Waters, L. and Koethe, J. R. (2020). Weight Gain Following Initiation of Antiretroviral Therapy: Risk Factors in Randomized Comparative Clinical Trials. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 71(6), 1379–1389. https://doi.org/10.1093/cid/ciz999.

Suzuki Kazuo, Levert Angelique, Yeung Julie, Starr, Mitchell; Cameron Jane, Williams Raffaella, Rismanto Nikolas, Stark Tayla, Druery Dylan, Prasad Salzeena, Ferrarini Cristina, Hanafi Imelda, McNally Leon Patrick, Cunningham Philip, Liu Zhixin, Ishida Takaomi, Huang Chin-Shiou, Oswald Velma, Evans Louise, Symonds Geoffrey, Brew Bruce James, Zaunders John. (2021). HIV-1 viral blips are associated with repeated and increasingly high levels of cell-associated HIV-1 RNA transcriptional activity. AIDS 35(13): 2095-2103. DOI: 10.1097/QAD.0000000000003001

Food and Drug Administration (FDA). (2022). FDA’s comprehensive database on antiretroviral drugs for HIV under PEPFAR, from a global perspective. Available at: https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=pepfar.page

United Nations Children’s Fund (UNICEF). (2024). Adolescent HIV prevention: UNICEF for every child. UNICEF. Available at: https://data.unicef.org/topic/hivaids/adolescents-young-people

van Vonderen, M. G., van Agtmael, M. A., Hassink, E. A., Milinkovic, A., Brinkman, K., Geerlings, S. E., Ristola, M., van Eeden, A., Danner, S. A., Reiss, P., & MEDICLAS study group. (2009). Zidovudine/lamivudine for HIV-1 infection contributes to limb fat loss. PLoS One, 4(5), e5647. https://doi.org/10.1371/journal.pone.0005647

World Health Organization. (2013). Consolidated guidelines on the use of antiretroviral drugs for treatment and prevention of HIV infection: Recommendations for a public health approach. Available at: http://apps.who.int/iris/bitstream/10665/85321/1/9789241505727_eng.pdf