Understanding zBMI Trajectories Before and After Dolutegravir Initiation

Presented at the Conference on Retroviruses and Opportunistic Infections 2026, this study from the IeDEA consortium examines how dolutegravir (DTG)–based antiretroviral therapy affects growth in children and adolescents living with HIV—a population for whom data have historically been limited. Although dolutegravir has become the standard of care for pediatric HIV treatment, concerns about weight gain observed in adult populations raised questions about its metabolic effects in younger patients.

To address this gap, Julie Jesson, PhD, researcher in epidemiology and biostatistics at the University of Toulouse, and Juan D. Medina, MD, MPH, research engineer at the Institut Necker Enfants Malades in Paris, led an analysis of over 29,000 children and adolescents living with HIV across Africa, Asia-Pacific, and Latin America and the Caribbean, tracking BMI-for-age z-scores (zBMI) across 3 distinct time windows: 48 weeks before dolutegravir initiation, 0 to 48 weeks after, and 48 to 96 weeks after.

In the interview, Medina described how the team modeled individual growth curves for each patient using multiple observations over time, then aggregated these to assess how zBMI slopes shifted around the moment of dolutegravir initiation. The analysis revealed a modest but measurable increase in zBMI in the first 48 weeks following dolutegravir start, a shift that was statistically significant but notably did not persist into the second year of follow-up.

Jesson explained how the team interprets this pattern as a "return-to-health" phenomenon rather than drug-driven excess weight gain. Children and adolescents perinatally acquiring HIV often experience chronic nutritional deficits and growth retardation stemming from immunosuppression and prolonged illness. When effective treatment is introduced, catch-up growth is an expected and clinically desirable outcome. Importantly, in this cohort, zBMI scores remained within normal ranges throughout follow-up, with no meaningful progression into overweight or obese categories. Medina reinforced this point by noting that the majority of patients began the study period already below recommended nutritional thresholds—meaning the early gains seen after dolutegravir initiation represented a movement toward healthy weight, not beyond it.