Risk of Cardiovascular Events in People with HIV (PWH) Treated with Integrase Strand-Transfer Inhibitors: The Debate...

Area of Science:

• Cardiology
• Infectious Diseases
• Pharmacology

Background:

• Cardiovascular disease (CVD) is a significant cause of morbidity and mortality in people with HIV (PWH).
• Antiretroviral therapies (ARTs), particularly integrase strand-transfer inhibitors (INSTIs), are suspected contributors to increased CVD risk in PWH, but their role requires further elucidation.

Purpose of the Study:

• To evaluate the association between INSTIs and the risk of developing cardiovascular disease (CVD) in people with HIV (PWH).
• To compare CVD incidence in PWH treated with INSTIs versus those on protease inhibitors (PIs) or non-nucleoside reverse transcriptase inhibitors (NNRTIs).

Main Methods:

• A multicenter, observational study involving 4984 PWH.
• Comparison of CVD incidence between INSTI-exposed (n=2357) and other ART-exposed (n=2599) groups.
• Analysis considered demographic and clinical characteristics, with follow-up periods of 2 years and complete study duration.

Main Results:

• Twenty-four cases of CVD occurred in the INSTI group, compared to 12 cases in the other ART groups.
• Univariate and multivariate analyses indicated a trend towards increased CVD risk in PWH exposed to INSTIs within the 2-year follow-up.
• This observed trend did not reach statistical significance.

Conclusions:

• The study suggests a potential, minimal role for INSTIs in increasing CVD risk among PWH.
• The hypothesis that INSTIs may contribute to CVD risk in PWH remains open and warrants further investigation.