Impact of integrase strand transfer inhibitors on cardiovascular disease in people with HIV.

PURPOSE: Integrase Strand Transfer Inhibitors (INSTIs) are effective and well-tolerated in HIV treatment, but their cardiovascular impact remains uncertain. This study evaluated the association between INSTI-based antiretroviral therapy (ART) and cardiovascular disease (CVD) risk in people with HIV (PWH).

METHODS

We conducted a retrospective cohort study using electronic health records and survey data from the All of Us research program. Adults with HIV on continuous ART for ≥ 1 year, free of CVD at baseline and within one year of ART initiation, were included. INSTI exposure was categorized by regimen status. Cox proportional hazards models assessed the association between INSTI use and CVD. A subgroup analysis examined INSTI-naïve individuals who later switched to INSTI-based ART.

RESULTS

Among 2175 PWH, 437 (20.09 %) experienced CVD events; 1715 (78.85 %) used INSTIs. INSTI-only (aHR = 0.65, 95 % CI: 0.50-0.83) and partial-INSTI use (aHR = 0.34, 95 % CI: 0.27-0.42) were linked to lower CVD risk. In the INSTI-naïve cohort (N = 1300), switching to INSTIs reduced CVD risk (aHR = 0.32, 95 % CI: 0.25-0.40). Older age (≥ 70) increased CVD risk.

CONCLUSIONS

INSTI-based ART may lower CVD risk among PWH. Further research is needed to validate these findings.

SUMMARY: INSTI-based ART was associated with reduced cardiovascular disease risk among people with HIV, suggesting potential cardioprotective effects that warrant further investigation.