Risk for Hypertriglyceridemia in Patients With HIV Infection Treated With Integrase Strand Transfer Inhibitor-Based Antiretroviral Therapy

The following article is a part of conference coverage from the IDWeek 2021, being held virtually from September 29 to October 3, 2021. The team at Infectious Disease Advisor will be reporting on the latest news and research conducted by leading experts in the field. Check back for more from the IDWeek 2021.

In Individuals with HIV infection, treatment with integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) was found to be associated with an increased risk for hypertriglyceridemia (HTG), according to research presented at IDWeek, held virtually from September 29 to October 3, 2021. Moreover, individuals treated with an INSTI-based ART regimen were also more likely to be prescribed adjunctive lipid-lowering therapy (LLT).

In this retrospective, observational study conducted at Wake Forest Baptist Health in North Carolina, researchers analyzed data from 132 adult patients (mean age, 42 years) with HIV between January 2004 and July 2019 to assess lipid changes associated with INSTI-based ART by comparing those who received INSTI-Based ART with those who received non-INSTI ART.

Patients were prescribed the same ART regimen for 6 or more consecutive months, and any unique ART regimens were considered “exposures.” Exposures that were defined as INSTI-based included an INSTI plus 1 or more nucleoside reverse transcriptase inhibitors (NRTI). Patients who had Non-INSTI exposures included those treated with either a protease inhibitor or a non-NRTI plus 1 or more NRTIs. Follow-up was up to 2 years per exposure.

Of the 132 patients included in the study, 69.3% were Black, 61.9% were men, 72 were treatment-naïve, and the mean BMI was 26.2 kg/m². A total of 192 unique exposures occurred among the included patients: 99 were INSTI-based and 93 were non-INSTI exposures. Of patients who received INSTI-based ART, 53.5% were treated with either bictegravir or dolutegravir.

The researchers noted that HTG occurred more often among patients with INSTI-based exposures vs those with non-INSTI exposures (13.1% vs 4.3%; P =.031). In addition, triglyceride concentrations were increased by mean of 10.1 mg/dL among patients with INSTI-based exposures and decreased by a mean of 15.0 mg/dL among those with non-INSTI exposures (P =.105). Among patients who received an INSTI-based ART and either tenofovir alafenamide, tenofovir disoproxil fumarate (TDF), or no tenofovir, 17.4%, 10.3%, and 8.3% developed HTG, respectively (P =.49).

Of note, patients who received an INSTI-based ART regimen were also more commonly prescribed LLT or an increased dose of pre-existing LLT vs those who received non-INSTI ART (14.1% vs 2.2%; P =.003).

In regard to changes in high- or low-density lipoproteins, the researchers observed no significant differences between patients who received INSTI-based ART and those who received non-INSTI ART.

The researchers noted that weight gain occurred among patients in both the INSTI and non-INSTI groups, with a mean increase of 3.8 kg (8.4 lb) and 2.1 kg (4.6 lb), respectively. Although all patients who received an INSTI-based ART regimen experienced weight gain, the mean increase in weight was greater among those whose regimens included TDF vs those whose regimens did not include TDF (4.8 kg [10.6 lb] vs 1.4 kg [3.1 lb]); however, the difference was not statistically significant (P =.053).

Because LLT was used among patients who received INSTI-based ART, the researchers were unable to fully characterize lipid changes. “Weight gain among INSTI recipients may be attenuated if TDF is included in the regimen,” the researchers concluded.

Disclosure: Some author(s) declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.

Reference

Gruss Z, Stone T, Johnson J, Morse C, Williamson J. A real-world study assessing the risk of lipid changes and other metabolic effects associated with integrase inhibitor-based antiretroviral therapy. Presented at: IDWeek 2021; September 29 to October 3, 2021. Poster 903.

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