Incidence of dyslipidemia in people with HIV who are treated with integrase inhibitors versus other antiretroviral agents

Abstract

Incidence of dyslipidemia in people with HIV who are treated with integrase inhibitors versus other antiretroviral agents The RESPOND Study Group M Objective: To compare the incidence of dyslipidemia in people with HIV receiving integrase inhibitors (INSTI) versus boosted protease inhibitors (PI/b) and nonnucleoside reverse transcriptase inhibitors (NNRTI) within RESPOND consortium of prospective cohorts. Methods: Participants were eligible if they were at least 18 years, without dyslipidemia and initiated or switched to a three-drug antiretroviral therapy (ART)-regimen consisting of either INSTI, NNRTI, or PI/b for the first time, between 1 January 2012 and 31 December 2018. Dyslipidemia was defined as random total cholesterol more than 240 mg/dl, HDL less than 35 mg/dl, triglyceride more than 200 mg/dl, or initiation of lipid-lowering therapy. Poisson regression was used to determine the adjusted incidence rate ratios. Follow-up was censored after 3 years or upon ART-regimen discontinuation or last lipid measurement or 31 December 2019, whichever occurred first. Results: Overall, 4577 people with HIV were eligible (INSTI ¼ 66.9%, PI/b ¼ 12.5%, and NNRTI ¼ 20.6%), 1938 (42.3%) of whom were ART-naive. During 1.7 (interquartile range, 0.6-3.0) median years of follow-up, 1460 participants developed dyslipidemia [incidence rate: 191.6 per 1000 person-years, 95% confidence interval (CI) 182.0-201.7]. Participants taking INSTI had a lower incidence of dyslipidemia compared with those on PI/b (adjusted incidence rate ratio 0.71; CI 0.59-0.85), but higher rate compared with those on NNRTI (1.35; CI 1.15-1.58). Compared with dolutegravir, the incidence of dyslipidemia was higher with elvitegravir/cobicistat (1.20; CI 1.00-1.43) and raltegravir (1.24; CI 1.02-1.51), but lower with rilpivirine (0.77; CI 0.63-0.94). Conclusion: In this large consortium of heterogeneous cohorts, dyslipidemia was less common with INSTI than with PI/b. Compared with dolutegravir, dyslipidemia was more common with elvitegravir/cobicistat and raltegravir, but less common with rilpivirine.

Antiretroviral Therapy Switch Rates and Switching Patterns in 16,069 People Living With HIV: A Nationwide, Population-Based Study in Japan

“…There were some concerns regarding switching of backbone drugs in the literature; PLWH who switched from a TDF-based to a TAFbased cART regimen showed increased low-density lipoprotein (LDL) values exceeding their cardiovascular risk targets. 18,19 In the present study, equally low switch rates were observed at one year for TAF, ABC, and TDF. However, the true impact of TAF on lipid pro les or cardiovascular risk was not evaluated and requires further study.…”

“…Of all patients who started an ART regimen from 2011 to 2019, 19 1). No signi cant differences were found in patients' characteristics between those treated with these three predominant anchor drug classes.…”

Analysis of antiretroviral therapy switch rate and switching pattern for people living with HIV from a national database in Japan

“…In addition, in recent years there are increasing number of new formulations containing INTIs being released. There were some concerns regarding switching of backbone drugs in the literature; PLWH who switched from a TDF-based to a TAF-based cART regimen showed increased low-density lipoprotein (LDL) values exceeding their cardiovascular risk targets 18 , 19 . In the present study, equally low switch rates were observed at 1 year for TAF, ABC, and TDF.…”

Weight Gain and Metabolic Syndrome in Human Immunodeficiency Virus Patients

“…A prospective study investigating the incidence of dyslipidemia in PLWH reported that older non-nucleoside reverse transcriptase inhibitors (NNRTIs), such as efavirenz and ritonavir-boosted protease inhibitors (PIs) containing ARTs, were associated with a greater risk of dyslipidemia than newer agents from the same class of ART. In addition, dyslipidemia was less common with INSTIs than with boosted PIs [ 32 ]. This report also found that, compared with dolutegravir, dyslipidemia was more common with elvitegravir/cobicistat and raltegravir but less common with rilpivirine.…”