AIDS (London, England) · 2026
Changes in weight and glycemia after initiation of integrase strand transfer inhibitors among people with HIV and diabetes.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Hwang Y Joseph, Lesko Catherine R, Brown Todd T, Alexander G Caleb, Althoff Keri N, Falade-Nwulia Oluwaseun, Moore Richard D, Zalla Lauren C, Tseng Eva, Koethe John R, Rebeiro Peter F, Marconi Vincent C, Silverberg Michael J, Horberg Michael A, Davy-Mendez Thibaut, Lang Raynell, Kassaye Seble G, Fojo Anthony Todd, North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of the International Epidemiologic Databases to Evaluate AIDS (IeDEA)
Аннотация
OBJECTIVE: Evaluate the impact of initiating integrase strand transfer inhibitor (INSTI) - vs. nonnucleoside reverse transcriptase inhibitor (NNRTI) - or protease inhibitor-based regimens on weight and glycemia among people with HIV (PWH) and type 2 diabetes.
DESIGN: Cohort study.
METHODS: From multisite HIV cohorts in the United States and Canada (2007-2022), we identified PWH with diabetes who newly initiated INSTI-based, NNRTI-based, or protease inhibitor-based therapy. We used inverse probability of treatment-weighted (IPTW) generalized linear models to compare changes in weight and hemoglobin A1c (HbA1c) at approximately 12 months after antiretroviral therapy (ART) initiation. We assessed time to at least 5% weight gain and to glucose-lowering therapy augmentation or HbA1c increase at least 0.5 percentage points with IPTW Cox regression.
RESULTS: Among 1279 PWH with diabetes, 548 initiated an INSTI-based regimen, 511 an NNRTI-based regimen, and 220 a protease inhibitor-based regimen. Compared with NNRTI users, INSTI users had greater adjusted mean weight gain [2.1 kg; 95% confidence interval (CI), 1.1-3.1], while the difference in HbA1c change was modest (0.2%; 95% CI, 0.0-0.5); both changes were similar between INSTI and protease inhibitor users. INSTI users had higher risk of at least 5% weight gain [adjusted hazard ratio (aHR), 1.35; 95% CI, 1.15-1.59] and glucose-lowering therapy augmentation or HbA1c increase at least 0.5% (aHR, 1.19; 95% CI, 1.02-1.41) compared with NNRTI users although similar risk vs. protease inhibitor users.
CONCLUSION: Among PWH with diabetes, initiating INSTIs conferred modestly greater weight gain and worse glycemic outcomes vs. NNRTIs, but outcomes comparable to PIs, which is recognized for adverse metabolic effects. These findings inform the metabolic implications of INSTIs and support clinical monitoring after ART initiation.
DESIGN: Cohort study.
METHODS: From multisite HIV cohorts in the United States and Canada (2007-2022), we identified PWH with diabetes who newly initiated INSTI-based, NNRTI-based, or protease inhibitor-based therapy. We used inverse probability of treatment-weighted (IPTW) generalized linear models to compare changes in weight and hemoglobin A1c (HbA1c) at approximately 12 months after antiretroviral therapy (ART) initiation. We assessed time to at least 5% weight gain and to glucose-lowering therapy augmentation or HbA1c increase at least 0.5 percentage points with IPTW Cox regression.
RESULTS: Among 1279 PWH with diabetes, 548 initiated an INSTI-based regimen, 511 an NNRTI-based regimen, and 220 a protease inhibitor-based regimen. Compared with NNRTI users, INSTI users had greater adjusted mean weight gain [2.1 kg; 95% confidence interval (CI), 1.1-3.1], while the difference in HbA1c change was modest (0.2%; 95% CI, 0.0-0.5); both changes were similar between INSTI and protease inhibitor users. INSTI users had higher risk of at least 5% weight gain [adjusted hazard ratio (aHR), 1.35; 95% CI, 1.15-1.59] and glucose-lowering therapy augmentation or HbA1c increase at least 0.5% (aHR, 1.19; 95% CI, 1.02-1.41) compared with NNRTI users although similar risk vs. protease inhibitor users.
CONCLUSION: Among PWH with diabetes, initiating INSTIs conferred modestly greater weight gain and worse glycemic outcomes vs. NNRTIs, but outcomes comparable to PIs, which is recognized for adverse metabolic effects. These findings inform the metabolic implications of INSTIs and support clinical monitoring after ART initiation.