Wits Study Finds New HIV Treatment Doravirine Causes Less Weight Gain Than Dolutegravir
- A South African clinical trial compared a doravirine-based HIV regimen against the standard dolutegravir treatment over 48 weeks
- The Wits University-led Opti-DOR study enrolled 600 participants across Gauteng and KwaZulu-Natal and tracked weight and viral outcomes
- Researchers have alerted the South African Department of Health about expanding first-line treatment options for people at risk of obesity
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A South African HIV study has found that a newer antiretroviral regimen causes significantly less weight gain than the country's current standard treatment, offering fresh hope for patients at risk of obesity-related health complications.
The Opti-DOR study, led by Ezintsha at the University of the Witwatersrand in partnership with the Africa Health Research Institute, tested a once-daily combination of tenofovir disoproxil fumarate, lamivudine, and doravirine against the widely used dolutegravir regimen. Results were presented at the 2026 International AIDS Society Conference on HIV Science and published in the Journal of the American Medical Association.
What the 48-week trial revealed
According to the report, the randomised trial followed 600 participants across urban Gauteng and rural KwaZulu-Natal over 48 weeks. Both regimens proved equally effective at suppressing HIV viral loads. However, the weight outcomes told a different story.
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Participants on the doravirine regimen gained a median of 3.0 kg over the trial period. Those on dolutegravir gained 5.0 kg. Total body fat increase also differed, rising by 1.5% in the doravirine group compared to 2.2% in those on dolutegravir.
This distinction matters because second-generation ARVs such as dolutegravir, while highly effective, are consistently linked to significant weight gain, particularly among Black women. Excess weight in turn raises the risk of diabetes, hypertension, and cardiovascular disease, making long-term management far more complex for patients.
Who would benefit from the new regimen
Lead author Dr Joana Woods was clear that doravirine is not intended to replace dolutegravir across the board. Instead, it is being proposed as a targeted first-line alternative for individuals who face a high risk of treatment-related obesity and cardiometabolic complications.
There is one important caveat: doravirine demands strict adherence. Inconsistent use carries a higher risk of the virus developing drug resistance compared to dolutegravir. During the trial, seven participants developed resistance to doravirine and were successfully switched to dolutegravir to restore viral suppression.
Because doravirine is already an approved and registered medicine, the research team has notified the South African National Department of Health and the South African Health Products Regulatory Authority about the findings, urging them to consider expanding flexible first-line treatment options for patients.
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More on HIV treatment and awareness
- Briefly News recently reported on a South African woman defending a polygamist HIV storyline in a popular Netflix series, sparking debate over its portrayal.
- In another story, an investigation revealed Zimbabwean farmers are illegally mixing human ARV drugs into chicken feed, with experts warning of serious health risks.
- A Boschkop man was charged with attempted murder after allegedly hiding his HIV status from his girlfriend throughout their relationship.
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Source: Briefly News
