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

Byonanebye et al. on behalf of the International Cohort Consortium of Infectious Disease (RESPOND ) aimed to compare the incidence of dyslipidemia in people living with HIV (PLWH) treated with integrase inhibitors (INSTI) versus other contemporary antiretroviral therapy (ART) regimens.

Participants were eligible if they were at least 18 years, without dyslipidemia and initiated or switched to a three-drug ART-regimen consisting of either INSTI, NNRTI, or boosted protease inhibitors (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.

Overall, 4’577 people with HIV were eligible (INSTI = 66.9%, PI/b = 12.5%, and NNRTI = 20.6%), 1’938 (42.3%) of whom were ART-naive. The median age [interquartile range (IQR)] was 43 (35–51) years. During 1.7 (IQR, 0.6–3.0) median years of follow-up, 1’460 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).

In conclusion, in this consortium of heterogeneous cohorts, the incidence of dyslipidemia in PLWH taking ART was high. The incidence in PLWH taking INSTI was lower than in PLWH taking PI/b and higher in those taking NNRTI. Compared with DTG, dyslipidemia was less common in PLWH taking rilpivirine, but more common in participants treated with elvitegravir/cobicistat or raltegravir. Due to higher efficacy, INSTI-based regimens could remain the ART of choice even in PLWH with high dyslipidemia. Rilpivirine could be considered as an ART option in PLWH with suppressed HIV RNA who are intolerant to INSTI. PLWH with traditional CVD risk factors and those taking PI/b should be monitored and offered lifestyle counseling.

PubMed