New research highlights the need to pair antiretroviral therapy with long-term chronic disease care.

By Collins Mtika

A new study led by Dr Melani Ratih Mahanani, a medical doctor and epidemiologist, has found that some people living with HIV in Malawi experience increased blood pressure after switching to a World Health Organization–recommended antiretroviral therapy (ART) regimen, even as most see only minimal changes in weight.

The findings come from an analysis of clinical data from 432 adults who transitioned to dolutegravir-based treatment, now the global standard.

According to the research, 11% of patients were newly diagnosed with hypertension after moving to dolutegravir, compared with 5.4% when they were taking earlier ART combinations such as tenofovir, lamivudine, and efavirenz.

Weight gain—previously a concern in some communities adopting dolutegravir—was described as “minimal” across the cohort.

Dr Mahanani’s team also reviewed historical data from 543 patients who were on older regimens before switching.

The goal was to test whether widely circulated reports of rapid weight gain or metabolic changes with dolutegravir held true in Malawi’s context.

 “Our objective was to determine the veracity of claims that this regimen leads to excessive weight gain,” the researcher noted, adding that the data showed only small, patient-specific variations.

Dolutegravir has become the preferred ART regimen worldwide because it is effective, affordable, and generally well tolerated.

The Malawi study contributes to a broader evidence base showing that while the drug remains safe, long-term HIV care must increasingly address chronic health conditions.

Dr Mahanani’s analysis found that rises in blood pressure were concentrated among people who already entered treatment with elevated readings.

By contrast, being female, having lower initial body weight, and maintaining good kidney function appeared to offer protection against hypertension during follow-up.

These patterns echo earlier findings across sub-Saharan Africa showing that health outcomes during ART often reflect a combination of age, activity levels, diet, and genetics.

The research also reaffirmed that cardiovascular changes are not limited to newer regimens.

Older ART drugs, including Efavirenz and Tenofovir, have previously been linked to slow but steady increases in heart-related risks over several years of use.

In one subset of 201 patients tracked for three years, 11.9% experienced later increases in cardiovascular risk.

More than 41 million people were living with HIV worldwide in 2024, including 21.1 million in Eastern and Southern Africa.

As treatment expands and survival improves, countries such as Malawi, with life expectancy rising to 66.37 years in 2025, are seeing new health needs emerge within HIV programmes.

“As people living with HIV grow older and remain on lifelong treatment, heart health becomes increasingly important,” Dr Mahanani explained.

She emphasised that increases in blood pressure “are not signs of treatment failure” but signals that HIV services must integrate screening for hypertension, diabetes, and cholesterol.

The study urges health systems to view metabolic monitoring as a standard component of HIV care rather than an additional task.

That includes routine checks of blood pressure and weight during clinic visits, early treatment for hypertension when needed, and consistent supplies of essential medicines.

Governments, the research notes, play a key role by updating national treatment guidelines, funding long-term monitoring systems, and training healthcare workers to recognise emerging metabolic risks.

Community-level support, such as peer counsellors and patient groups, can also help people stay on treatment while managing lifestyle adjustments.

Despite the identified risks, Dr Mahanani stresses that interrupting HIV treatment is far more dangerous. Stopping ART allows the virus to rebound, weakens the immune system, and increases the likelihood of transmission.

Instead, patients are encouraged to watch for symptoms such as headaches, dizziness, or rapid weight changes and discuss them openly with providers.

The Malawi study ultimately reinforces a central message: HIV care is evolving. As ART enables millions to live longer, healthier lives, integrating chronic disease prevention and management will be crucial to sustaining those gains.