Update on Adverse Effects of HIV Integrase Inhibitors

Area of Science:

• Infectious Diseases
• Pharmacology
• HIV/AIDS Management

Background:

• Integrase strand transfer inhibitors (INSTIs) are a preferred class of antiretrovirals due to high potency.
• Real-world data highlight concerns regarding neuropsychiatric adverse events and weight gain associated with INSTIs.
• Understanding these adverse events is crucial for managing HIV/AIDS and improving patient quality of life.

Purpose of the Study:

• To provide an updated review of adverse events associated with INSTIs.
• To specifically address neuropsychiatric adverse events and weight gain, the most significant concerns.
• To summarize safety data in adults, with brief mentions of pregnant women and children/adolescents.

Main Methods:

• Review of recent studies and real-life data on INSTI adverse events.
• Focus on neuropsychiatric and weight gain side effects.
• Inclusion of data concerning pregnant women and pediatric populations.

Main Results:

• Dolutegravir (DTG) is associated with the highest burden of neuropsychiatric side effects.
• Weight gain is reported across all INSTIs, with potential differential effects based on sex and ethnicity.
• Raltegravir is the only INSTI recommended without caution for women of childbearing age due to neural tube defect concerns with DTG.

Conclusions:

• INSTIs are generally well-tolerated and potent, but clinicians and patients must be aware of potential adverse events.
• Monitoring for neuropsychiatric effects and weight gain is essential, especially with DTG.
• Further research into long-term effects, pharmacogenetics, and safety in pregnancy is warranted.