García-Abellán Javier, García José A, Padilla Sergio, Fernández-González Marta, Agulló Vanesa, Mascarell Paula, Botella Ángela, Gutiérrez Félix, Masiá Mar
Infectious Diseases Unit, Hospital General Universitario de Elche and Universidad Miguel Hernández de Elche, Alicante, Spain.
CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
J Antimicrob Chemother. 2025 Jan 3;80(1):126-137. doi: 10.1093/jac/dkae383.
The role of integrase strand transfer inhibitors (INSTI) in the cardiovascular risk of people with HIV is controversial.
To assess the association of INSTI to subclinical atherosclerosis progression measured with the carotid intima-media thickness (cIMT).
Prospective study in virologically suppressed people with HIV receiving INSTI- or NNRTI-based regimens. cIMT was measured at baseline, 48 and 96 weeks. cIMT progression was analysed both as a continuous and categorical variable, defined as cIMT increase ≥ 10% and/or new carotid plaque. Adjustments through Cox proportional hazard regression and linear mixed models, and propensity score matching were conducted.
190 participants were recruited and 173 completed the 96 week follow-up. 107 (56.3%) were receiving an INSTI-containing, 128 (67.4%) a NNRTI-containing and 45 (23.7%) a NNRTI plus an INSTI-containing regimen. The overall median (IQR) 2-year change of cIMT was 0.029 (-0.041 to 0.124) mm; 87 (45.8%) participants experienced a cIMT increase ≥ 10%, of whom 54 (28.4%) developed a new carotid plaque. Adjusted Cox regression showed no differences between INSTI and NNRTI groups in the categorical 2-year progression of cIMT, both including or excluding participants receiving INSTI + NNRTI. Similar results were observed for the continuous cIMT increase through adjusted linear mixed models. Propensity score matching showed no significant differences in the 2 year cIMT change between treatment groups [0.049 mm (-0.031-0.103) in the INSTI group versus 0.047 mm (-0.023-0.115) in the NNRTI group; P = 0.647]. cIMT progression was associated with traditional cardiovascular risk factors.
INSTI-based regimens are not associated with increased progression of subclinical atherosclerosis when compared to NNRTI.
整合酶链转移抑制剂（INSTI）在HIV感染者心血管风险中的作用存在争议。
评估INSTI与通过颈动脉内膜中层厚度（cIMT）测量的亚临床动脉粥样硬化进展之间的关联。
对接受基于INSTI或基于非核苷类逆转录酶抑制剂（NNRTI）方案的病毒学抑制的HIV感染者进行前瞻性研究。在基线、48周和96周时测量cIMT。cIMT进展作为连续变量和分类变量进行分析，分类变量定义为cIMT增加≥10%和/或出现新的颈动脉斑块。通过Cox比例风险回归和线性混合模型以及倾向得分匹配进行调整。
招募了190名参与者，173名完成了96周的随访。107名（56.3%）接受含INSTI方案，128名（67.4%）接受含NNRTI方案，45名（23.7%）接受含NNRTI加INSTI方案。cIMT的总体中位数（IQR）2年变化为0.029（-0.041至0.124）mm；87名（45.8%）参与者的cIMT增加≥10%，其中54名（28.4%）出现了新的颈动脉斑块。调整后的Cox回归显示，在cIMT的分类2年进展方面，INSTI组和NNRTI组之间无差异，无论是否包括接受INSTI+NNRTI的参与者。通过调整后的线性混合模型对连续的cIMT增加进行分析也观察到类似结果。倾向得分匹配显示治疗组之间2年cIMT变化无显著差异[INSTI组为0.049mm（-0.03l至0.103），NNRTI组为0.047mm（-0.023至0.115）；P=0.647]。cIMT进展与传统心血管危险因素相关。
与NNRTI相比，基于INSTI的方案与亚临床动脉粥样硬化进展增加无关。
