Body Composition Changes in Children Living With HIV Initiated on Dolutegravir or Protease Inhibitors in the CHAPAS-4 Trial.
Eva Natukunda, Alex J Szubert, Mutsa Bwakura-Dangarembizi et al.
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In 30 seconds
This randomized factorial trial analysis examined body-composition changes over 96 weeks in children with HIV switching to second-line antiretroviral therapy. Among 841 participants, dolutegravir and atazanavir/ritonavir exposure, compared with lopinavir/ritonavir, was associated with greater gains in fat-free mass (+0.79 kg and +0.85 kg, respectively) and muscle mass (+0.82 kg for each). Darunavir/ritonavir, tenofovir alafenamide and prior nevirapine exposure were associated with greater fat-mass accrual. The findings distinguish changes in lean and fat compartments across treatment exposures.
Key findings
- Compared with lopinavir/ritonavir, dolutegravir and atazanavir/ritonavir were associated with higher fat-free mass: +0.79 kg and +0.85 kg, respectively.
- Muscle mass was higher with dolutegravir and atazanavir/ritonavir than with lopinavir/ritonavir, by +0.82 kg for each.
- Tenofovir alafenamide and darunavir/ritonavir exposures were associated with higher fat mass: +0.32 kg and +0.33 kg, respectively.
- Females had greater fat accrual than males (+4.66% body fat and +1.32 kg fat mass; both P < 0.001).
Why it matters
Body-composition changes during paediatric HIV treatment are not uniform across antiretroviral exposures: gains may involve lean tissue, fat, or both. Distinguishing these compartments can help clinicians interpret weight-related changes over time. The authors note that early fat gain may reflect return to health, whereas sustained increases may have metabolic implications.
What to keep in mind
Body composition was assessed using bioelectric impedance analysis, and follow-up was limited to 96 weeks; the abstract does not report longer-term outcomes.