Metabolic Changes in Pediatric HIV Patients on Contemporary Antiretroviral Therapy: Implications for Research and Interventions

Despite advances in antiretroviral therapy, children living with HIV remain at increased risk for early cardiometabolic disease. Although second-generation integrase strand transfer inhibitors such as dolutegravir (DTG) have been associated with weight gain in adults, pediatric clinical trials have demonstrated a largely weight-neutral metabolic profile. Emerging observational data, however, report excess DTG-associated weight gain among children and adolescents living in increasingly obesogenic environments. As pediatric HIV epidemiology shifts from undernutrition toward a growing burden of obesity, HIV care should incorporate longitudinal metabolic monitoring, nutritional counseling, and continued research on the long-term cardiometabolic effects of DTG.