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HIV — SCE Infectious Diseases MCQ

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ModerateHIV MedicineHIVSCE Infectious Diseases

A 37-year-old man with HIV on Tenofovir AF/Emtricitabine/Dolutegravir has been virally suppressed for 4 years. He now weighs 105 kg (BMI 34). His pre-ART weight was 78 kg. He has developed impaired fasting glucose. Which component of his ART is most strongly associated with weight gain?

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Correct answer: A — Dolutegravir

Integrase inhibitors, particularly Dolutegravir and Bictegravir, are most strongly associated with weight gain, especially when combined with Tenofovir AF (which has less weight-suppressive effect than Tenofovir DF). The ADVANCE and NAMSAL trials demonstrated greater weight gain with DTG-based regimens. TAF also contributes independently compared to TDF. There is no current recommendation to switch ART solely for weight gain, but metabolic risk should be actively managed. BHIVA 2025 acknowledges this as a growing concern.

Reference: BHIVA 2025 – ART guidelines (2025 interim update); EACS 2025 – Guidelines