Determinants of Metabolic Syndrome in Virally Suppressed People Living with HIV: A Single-Center Comparative Analysis of Antiretroviral Regimens.

Background

Metabolic complications and weight gain have emerged as primary concerns among virologically suppressed and immunologically competent people living with HIV. Particularly integrase strand transfer inhibitors (INSTIs) and tenofovir alafenamide (TAF) are being connected with this issue.

Objectives

This study aimed to evaluate the prevalence of metabolic syndrome (MetS) and its components within a highly homogeneous, virologically suppressed cohort, assessing the impact of antiretroviral therapy (ART) and HIV-unrelated factors.

Methods

We conducted a single-center cross-sectional analysis of 93 HIV-positive patients receiving stable ART for >2 years, in Wrocław, Poland. To minimize confounding, individuals with HBV/HCV co-infections or significant alcohol use were excluded. Participants were stratified primarily by regimen, INSTI/TAF-based (n = 50) vs. PI/TAF-based (n = 28), and secondarily by the particular drugs taken. Clinical assessment included anthropometric parameters, lipid profiles, and glucose metabolism.

Results

The prevalence of MetS was 10.8%. No statistically significant differences were observed in the incidence of MetS, insulin resistance, or dyslipidemia between the INSTI/TAF and PI/TAF groups. A marginally significant trend toward lower total cholesterol was identified in patients receiving dolutegravir/TAF compared to those on darunavir/TAF.

Conclusions

In this stable Caucasian cohort with long-term viral suppression, we found no statistically significant differences in metabolic outcomes between modern INSTI- and PI-based regimens. However, due to the limited sample size and low statistical power, these findings do not prove clinical equivalence. Our results suggest that in particular tightly selected settings of well-controlled patients, traditional risk factors and lifestyle may remain the primary drivers of metabolic health, although modest drug-related effects cannot be ruled out.