Nathan A Summers1,2, Cecile D Lahiri1, Christine D Angert3, Amalia Aldredge4, C Christina Mehta3, Ighovwerha Ofotokun1, Anne M Kerchberger4, Deborah Gustafson5, Sheri D Weiser6, Seble Kassaye7, Deborah Konkle-Parker8, Anjali Sharma9, Adaora A Adimora10, Hector Bolivar11, Jennifer Cocohoba12, Audrey L French13, Elizabeth T Golub14, Anandi N Sheth1. 1. Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA. 2. Department of Medicine, Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, TN. 3. Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA. 4. Emory University School of Medicine, Atlanta, GA. 5. Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY. 6. Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco School of Medicine, San Francisco, CA. 7. Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC. 8. Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS. 9. Department of Medicine, Albert Einstein College of Medicine, Bronx, NY. 10. Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC. 11. Department of Medicine, Division of Infectious Diseases, University of Miami Health System, Miami, FL. 12. Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA. 13. Division of Infectious Diseases, CORE Center/Stroger (Cook County) Hospital, Chicago, IL; and. 14. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Abstract
BACKGROUND: Integrase strand transfer inhibitors (INSTIs) have been associated with weight gain among women living with HIV. We aimed to investigate the association between INSTIs and change in cardiometabolic risk indicators. SETTING: Retrospective cohort. METHODS: Data from 2006 to 2017 were analyzed from women living with HIV enrolled in the longitudinal Women's Interagency HIV Study who were virally controlled on antiretroviral therapy (ART) for ≥5 consecutive semiannual visits. Women who switched/added an INSTI to ART (INSTI group) were compared with women who remained on non-INSTI ART (non-INSTI group). Outcomes included changes in fasting lipids and glucose, hemoglobin A1c (HbA1c), blood pressure (BP), and incident diabetes, hypertension, and insulin resistance. Outcomes were measured 6-12 months before and 6-18 months after INSTI switch/add in the INSTI group with comparable visits in the non-INSTI group. Longitudinal linear regression models compared change over time in each outcome by the study group. RESULTS: One thousand one hundred eighteen participants (234 INSTI, 884 non-INSTI) were followed for a median 2.0 (Q1 1.9, Q3 2.0) years. Participants were median age 49 years, 61% Black, and 73% overweight or obese (body mass index ≥25 kg/m). Compared with non-INSTI, the INSTI group experienced greater increases in HbA1c (+0.05 vs. -0.06 mg/dL, P = 0.0318), systolic BP (+3.84 vs. +0.84 mm Hg, P = 0.0191), and diastolic BP (+1.62 vs. -0.14 mm Hg, P = 0.0121), with greatest change in HbA1c among women on INSTIs with ≥5% weight gain. CONCLUSIONS: INSTI use was associated with unfavorable changes in HbA1c and systolic and diastolic BP during short-term follow-up. Further research is needed to understand long-term cardiometabolic effects of INSTI use.
BACKGROUND: Integrase strand transfer inhibitors (INSTIs) have been associated with weight gain among women living with HIV. We aimed to investigate the association between INSTIs and change in cardiometabolic risk indicators. SETTING: Retrospective cohort. METHODS: Data from 2006 to 2017 were analyzed from women living with HIV enrolled in the longitudinal Women's Interagency HIV Study who were virally controlled on antiretroviral therapy (ART) for ≥5 consecutive semiannual visits. Women who switched/added an INSTI to ART (INSTI group) were compared with women who remained on non-INSTI ART (non-INSTI group). Outcomes included changes in fasting lipids and glucose, hemoglobin A1c (HbA1c), blood pressure (BP), and incident diabetes, hypertension, and insulin resistance. Outcomes were measured 6-12 months before and 6-18 months after INSTI switch/add in the INSTI group with comparable visits in the non-INSTI group. Longitudinal linear regression models compared change over time in each outcome by the study group. RESULTS: One thousand one hundred eighteen participants (234 INSTI, 884 non-INSTI) were followed for a median 2.0 (Q1 1.9, Q3 2.0) years. Participants were median age 49 years, 61% Black, and 73% overweight or obese (body mass index ≥25 kg/m). Compared with non-INSTI, the INSTI group experienced greater increases in HbA1c (+0.05 vs. -0.06 mg/dL, P = 0.0318), systolic BP (+3.84 vs. +0.84 mm Hg, P = 0.0191), and diastolic BP (+1.62 vs. -0.14 mm Hg, P = 0.0121), with greatest change in HbA1c among women on INSTIs with ≥5% weight gain. CONCLUSIONS: INSTI use was associated with unfavorable changes in HbA1c and systolic and diastolic BP during short-term follow-up. Further research is needed to understand long-term cardiometabolic effects of INSTI use.
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