The introduction of antiretroviral therapy (ART) has led to a decline in HIV-related mortality, but the onset of obesity and metabolic disorders after treatment initiation is increasingly recognized. Weight gain after initiating ART, especially in patients with normal weight or overweight, may increase the risk of cardiovascular and metabolic diseases. Evidence suggests that the use of the integrase inhibitor dolutegravir (DTG) is associated with greater weight gain in this population. This study aimed to investigate a possible correlation between DTG use and the development of metabolic disorders in people living with HIV (PLHIV).

Prospective cohort study conducted in a referral center in southern Brazil. Patients aged 18 years or older using DTG, with at least one annual medical visit, were included. Pregnant women, patients coinfected with hepatitis B, and those without recent laboratory tests were excluded. The sample consisted of 621 patients, with 511 using DTG and 110 on regimens without DTG. Variables analyzed included age, sex, BMI, viral load, and laboratory tests. Metabolic syndrome was classified according to NCEP-ATP III criteria.

Among DTG users, 55% were male, with predominant ages between 40 and 49 years. Of 169 patients with recorded BMI, 64.5% were overweight or obese, and 82 had metabolic syndrome. Viral load was undetectable in 73.2%. In the non-DTG group, men predominated (61.8%), mostly aged 50–59 years. Of 43 patients with recorded BMI, 62.8% were overweight and 43 had metabolic syndrome. Although the absolute number of cases was higher in the DTG group, the proportion of metabolic syndrome was higher in the non-DTG group. However, grade II and III obesity were more frequent among DTG users.

Metabolic syndrome was present in both groups, with a higher proportion in the non-DTG group, suggesting that dolutegravir alone is not associated with a higher metabolic risk. However, the greater prevalence of obesity among DTG users indicates a possible association with weight gain. Therefore, besides DTG use, factors such as age, treatment duration, therapeutic regimen, and clinical profile should be considered when assessing metabolic risk.