Starting or Switching to an Integrase Inhibitor-Based Regimen Affects PTSD Symptoms in Women with HIV.,AIDS and Behavior

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Starting or Switching to an Integrase Inhibitor-Based Regimen Affects PTSD Symptoms in Women with HIV.
AIDS and Behavior ( IF 2.7 ) Pub Date : 2020-07-07 , DOI: 10.1007/s10461-020-02967-2
Asante R Kamkwalala ₁ , Kunbo Wang ₂ , Jane O'Halloran ₃ , Dionna W Williams _{4,

5} , Raha Dastgheyb ₁ , Kathryn C Fitzgerald ₁ , Amanda B Spence ₆ , Pauline M Maki ₇ , Deborah R Gustafson ₈ , Joel Milam ₉ , Anjali Sharma ₁₀ , Kathleen M Weber ₁₁ , Adaora A Adimora ₁₂ , Igho Ofotokun ₁₃ , Anandi N Sheth ₁₃ , Cecile D Lahiri ₁₃ , Margaret A Fischl ₁₄ , Deborah Konkle-Parker ₁₅ , Yanxun Xu _{3,

16} , Leah H Rubin _{1,

17,

18}

Affiliation

Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/ Meyer 6-113, Baltimore, MD, 21287-7613, USA.
Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, USA.
Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Medicine, Division of Infectious Disease and Travel Medicine, Georgetown University, Washington, DC, USA.
Departments of Psychiatry, Psychology and OB/GYN, University of Illinois at Chicago, Chicago, IL, USA.
Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA.
Institute for Health Promotion & Disease Prevention Research, University of Southern California, Los Angeles, CA, USA.
Albert Einstein College of Medicine, Bronx, NY, USA.
CORE Center, Cook County Health and Hektoen Institute of Medicine, Chicago, IL, USA.
Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, USA.
University of Miami Miller School of Medicine, Miami, FL, USA.
Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA.
Division of Biostatistics and Bioinformatics at The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

As the use of Integrase inhibitor (INSTI)-class antiretroviral medications becomes more common to maintain long-term viral suppression, early reports suggest the potential for CNS side-effects when starting or switching to an INSTI-based regimen. In a population already at higher risk for developing mood and anxiety disorders, these drugs may have significant effects on PTSD scale symptom scores, particularly in women with HIV (WWH). A total of 551 participants were included after completing ≥ 1 WIHS study visits before and after starting/switching to an INSTI-based ART regimen. Of these, 14% were ART naïve, the remainder switched from primarily a protease inhibitor (PI) or non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen. Using multivariable linear mixed effects models, we compared PTSD Civilian Checklist subscale scores before and after a “start/switch” to dolutegravir (DTG), raltegravir (RAL), or elvitegravir (EVG). Start/switch to EVG improved re-experiencing subscale symptoms (P’s < 0.05). Switching to EVG improved symptoms of avoidance (P = 0.01). Starting RAL improved arousal subscale symptoms (P = 0.03); however, switching to RAL worsened re-experiencing subscale symptoms (P < 0.005). Starting DTG worsened avoidance subscale symptoms (P = 0.03), whereas switching to DTG did not change subscale or overall PTSD symptoms (P’s > 0.08). In WWH, an EVG-based ART regimen is associated with improved PTSD symptoms, in both treatment naïve patients and those switching from other ART. While a RAL-based regimen was associated with better PTSD symptoms than in treatment naïve patients, switching onto a RAL-based regimen was associated with worse PTSD symptoms. DTG-based regimens either did not affect, or worsened symptoms, in both naïve and switch patients. Further studies are needed to determine mechanisms underlying differential effects of EVG, RAL and DTG on stress symptoms in WWH.

中文翻译：

开始或改用基于整合酶抑制剂的治疗方案会影响感染 HIV 的女性的 PTSD 症状。

随着使用整合酶抑制剂 (INSTI) 类抗逆转录病毒药物来维持长期病毒抑制变得越来越普遍，早期报告表明，在开始或切换到基于 INSTI 的方案时可能会出现 CNS 副作用。在已经有较高风险患上情绪障碍和焦虑症的人群中，这些药物可能对 PTSD 量表症状评分有显着影响，尤其是在感染 HIV 的女性 (WWH) 中。在开始/切换到基于 INSTI 的 ART 方案之前和之后完成 ≥ 1 次 WIHS 研究访问后，共有 551 名参与者被纳入。其中，14% 是 ART 幼稚的，其余的从主要基于蛋白酶抑制剂 (PI) 或非核苷类逆转录酶抑制剂 (NNRTI) 的方案转变而来。使用多变量线性混合效应模型，我们比较了“开始/转换”到多替拉韦 (DTG)、拉替拉韦 (RAL) 或艾替拉韦 (EVG) 之前和之后的 PTSD 平民检查表子量表分数。开始/切换到 EVG 改进的再体验子量表症状（P < 0.05)。改用 EVG 改善了回避症状 ( P = 0.01)。开始 RAL 改善觉醒分量表症状 ( P = 0.03)；然而，改用 RAL 会恶化再体验分量表症状 ( P < 0.005)。开始使用 DTG 会使回避子量表症状恶化 ( P = 0.03)，而改用 DTG 不会改变子量表或整体 PTSD 症状 ( P的 > 0.08)。在 WWH 中，基于 EVG 的 ART 方案与改善的 PTSD 症状相关，无论是对于未接受过治疗的患者还是从其他 ART 转换而来的患者。虽然基于 RAL 的方案与未接受治疗的患者相比具有更好的 PTSD 症状，但转换为基于 RAL 的方案与更严重的 PTSD 症状相关。以 DTG 为基础的治疗方案对初治患者和转换患者均没有影响或加重症状。需要进一步的研究来确定 EVG、RAL 和 DTG 对 WWH 应激症状的不同影响的潜在机制。

更新日期：2020-07-07

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