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/m²). 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.

中文翻译：

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病毒控制女性中与使用整合酶链转移抑制剂相关的代谢变化

 背景：

整合酶链转移抑制剂 (INSTI) 与感染艾滋病毒的女性体重增加有关。我们的目的是调查 INSTI 与心脏代谢风险指标变化之间的关联。

 环境：

 回顾性队列。

 方法：

对参加纵向妇女机构间艾滋病毒研究的艾滋病毒感染者 2006 年至 2017 年的数据进行了分析，这些妇女接受抗逆转录病毒治疗 ( ART ) 进行病毒控制，连续半年就诊 ≥5 次。将INSTI转为ART或添加 INSTI 的女性（ INSTI组）与继续接受非INSTI ART 的女性（非INSTI组）进行比较。结果包括空腹血脂和血糖、糖化血红蛋白 (HbA1c)、血压 ( BP ) 以及糖尿病、高血压和胰岛素抵抗的变化。在INSTI组中在INSTI转换/添加之前 6-12 个月和之后 6-18 个月测量结果，并在非INSTI组中进行可比较的就诊。纵向线性回归模型比较了研究组每个结果随时间的变化。

 结果：

对 1118 名参与者（234 名INSTI ，884 名非INSTI ）进行了中位随访 2.0 年（第一季度 1.9，第三季度 2.0）年。参与者的中位年龄为 49 岁，61% 为黑人，73% 为超重或肥胖（体重指数≥25 kg/m ² ）。与非INSTI相比， INSTI组的 HbA1c（+0.05 vs. -0.06 mg/dL， P = 0.0318）、收缩压（+3.84 vs. +0.84 mm Hg， P = 0.0191）和舒张压增加更大。 （+1.62 vs. -0.14 mm Hg， P = 0.0121），服用 INSTI 且体重增加 ≥5% 的女性 HbA1c 变化最大。

 结论：

在短期随访期间， INSTI 的使用与 HbA1c 以及收缩压和舒张压的不利变化相关。需要进一步研究来了解INSTI使用的长期心脏代谢影响。