Axel Ursenbach1, Vincent Max2, Marine Maurel2, Firouzé Bani-Sadr3,4, Amandine Gagneux-Brunon5, Rodolphe Garraffo6, Isabelle Ravaux7, Olivier Robineau8, Alain Makinson9, David Rey1. 1. Le Trait d'Union, HIV-Infection Care Center, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. 2. UMR1027, INSERM, Université Toulouse III Paul-Sabatier, Toulouse, France. 3. Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Reims University Hospital, Reims, France. 4. Reims Champagne-Ardenne University, EA-4684/SFR CAP-SANTE, Reims, France. 5. Department of Infectious Diseases, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France. 6. Clinical Pharmacology and Toxicology Department, Centre Hospitalier Universitaire de Nice, Nice, France. 7. Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France. 8. Infectious Diseases Department, University Hospital of Tourcoing, France. 9. Department of Infectious Diseases, Montpellier University Hospital, Montpellier, France.
Abstract
BACKGROUND: Integrase strand transfer inhibitors (INSTIs) are increasingly used in patients living with HIV due to their safety, effectiveness and high genetic barrier. However, an association with weight gain has recently been suggested and several cases of diabetes mellitus have been reported with raltegravir and dolutegravir. The long-time metabolic impact of these recent molecules remains unclear. OBJECTIVES: To assess if an INSTI as a third agent is statistically associated with new-onset diabetes mellitus compared with an NNRTI or a PI. PATIENTS AND METHODS: Patients undergoing first-line combined ART (cART) without diabetes at baseline were retrospectively included from the Dat'AIDS French cohort study (ClinicalTrials.gov NCT02898987). Incident diabetes mellitus was defined as a notification of new diabetes in the medical history, a glycated haemoglobin (HbA1c) level superior to 7.5% or the start of a diabetes therapy following the initiation of ART. RESULTS: From 2009 to 2017, 19 462 patients were included, among which 265 cases of diabetes mellitus occurred. Multivariate and survival analyses did not highlight an increase in new-onset diabetes in patients undergoing cART with an INSTI as a third agent compared with an NNRTI or a PI. BMI >30 kg/m2, age >37 years old (in survival analysis), black race or Hispanic ethnicity, arterial hypertension and AIDS were associated with a higher proportion of incident diabetes. CONCLUSIONS: INSTIs were not statistically associated with new-onset diabetes. However, clinicians should remain aware of this possible metabolic comorbidity, particularly in patients with a high BMI and older patients.
BACKGROUND: Integrase strand transfer inhibitors (INSTIs) are increasingly used in patients living with HIV due to their safety, effectiveness and high genetic barrier. However, an association with weight gain has recently been suggested and several cases of diabetes mellitus have been reported with raltegravir and dolutegravir. The long-time metabolic impact of these recent molecules remains unclear. OBJECTIVES: To assess if an INSTI as a third agent is statistically associated with new-onset diabetes mellitus compared with an NNRTI or a PI. PATIENTS AND METHODS: Patients undergoing first-line combined ART (cART) without diabetes at baseline were retrospectively included from the Dat'AIDS French cohort study (ClinicalTrials.gov NCT02898987). Incident diabetes mellitus was defined as a notification of new diabetes in the medical history, a glycated haemoglobin (HbA1c) level superior to 7.5% or the start of a diabetes therapy following the initiation of ART. RESULTS: From 2009 to 2017, 19 462 patients were included, among which 265 cases of diabetes mellitus occurred. Multivariate and survival analyses did not highlight an increase in new-onset diabetes in patients undergoing cART with an INSTI as a third agent compared with an NNRTI or a PI. BMI >30 kg/m2, age >37 years old (in survival analysis), black race or Hispanic ethnicity, arterial hypertension and AIDS were associated with a higher proportion of incident diabetes. CONCLUSIONS: INSTIs were not statistically associated with new-onset diabetes. However, clinicians should remain aware of this possible metabolic comorbidity, particularly in patients with a high BMI and older patients.
Authors: Archana Asundi; Alex Olson; Wenqing Jiang; Swati P Varshney; Laura F White; Manish Sagar; Nina H Lin Journal: AIDS Res Hum Retroviruses Date: 2022-01-10 Impact factor: 2.205
Authors: Frank Mulindwa; Habiba Kamal; Barbara Castelnuovo; Robert C Bollinger; Jean-Marc Schwarz; Nele Brussealers Journal: PLoS One Date: 2022-03-02 Impact factor: 3.752