Mortality using raltegravir versus other integrase strand-transfer inhibitors in people with HIV in Europe and Australia: a prospective multicentre study
Raltegravir (RAL) was the first integrase inhibitor and remains an antiretroviral treatment option for people with HIV in many places. However, some earlier studies raised concerns about higher mortality among people starting RAL compared with newer integrase inhibitors. In this study, Tusch et al. used data from the RESPOND consortium—a large collaboration of cohorts from Europe and Australia—to compare mortality between people initiating RAL and those starting other integrase inhibitors.
The study included more than 20’000 people with HIV who started an integrase inhibitor between 2012 and 2021. Overall, mortality rates appeared higher among people starting RAL. However, those starting RAL were also older, had more comorbidities (including kidney disease, cardiovascular disease, and cancer), and had higher HIV viral loads compared to individuals who started other integrase inhibitors—factors that themselves increase mortality risk.
After accounting for these differences, there was no clear evidence that RAL use is associated with higher mortality compared with other integrase inhibitors (adjusted hazard ratio 1.13, 95% confidence interval 0.93 – 1.34). Instead, the findings suggest that the initially observed higher mortality is explained by clinicians preferentially prescribing RAL to people with more advanced illness or complex clinical situations.
In summary, this large international analysis indicates that RAL itself does not increase mortality risk. Higher death rates previously observed among RAL users are likely related to underlying health conditions rather than the drug and thus, RAL remains a treatment option when clinically indicated.