More evidence that integrase inhibitors don’t raise heart disease risk

[Jim Allen]

Good news, I suppose. Although, had it been bad news, I would still have to take the meds. 

Aidsmap article in full: More evidence that integrase inhibitors don’t raise heart disease risk Keith Alcorn 10 November 2023

In Brief:

Integrase inhibitors do not increase the risk of major cardiovascular events such as a heart attack or stroke compared to other types of antiretroviral drug over four years of follow-up, a large multinational study reports in Lancet HIV.

The study confirms research from the Swiss HIV Cohort, which used a similar method of calculating the risk, and contradicts the findings of a study of people with HIV in Europe and Australia which found a raised risk during the first two years on treatment.

Studies looking at the risk of cardiovascular disease in people with HIV have produced contradictory results. A large North American study found the risk of cardiovascular disease was lower in people taking integrase inhibitors compared to other antiretrovirals, a Swiss study found the risk was the same and a European and Australian study found the risk was higher.

But all these findings come from observational studies. Although researchers can use statistical methods to adjust for biases, these methods do not have the same rigour as a randomised clinical trial, in which confounding factors tend to be equally distributed between groups by random assignment of participants to a treatment.



The study looked for major cardiovascular events: stroke, heart attack, clinical intervention for a cardiac problem or undefined major events. It compared 10,767 previously untreated people who started treatment with an integrase inhibitor and 8292 people who started another type of antiretroviral regimen between 2013 and 2023. The analysis excluded people with a previous diagnosis of cancer.

The median age of previously untreated participants was 39, just over 85% were male and the median CD4 count upon starting treatment was approximately 350.

In the intent-to-treat analysis, which assessed everyone according to their initial therapy and followed them for four years, there were 43 cardiovascular events in the integrase treatment group and 52 in the non-integrase group. After adjusting for demographic and HIV-related factors, smoking, body mass and metabolic factors, the 4-year risk was 0.76% in people taking an integrase inhibitor and 0.75% in people taking another type of antiretroviral. When the analysis was restricted to people who stayed on their initial class of antiretroviral (per-protocol) throughout follow-up, the adjusted risk was 0.6% in the integrase inhibitor group and 0.88% in the non-integrase inhibitor group.

[leatherman]

Although, had it been bad news, I would still have to take the meds. 

LOL that sounds like a lot of the early meds. Even when they had bad side effects, you still had to take them. LOL

[Jim Allen]

LOL that sounds like a lot of the early meds. Even when they had bad side effects, you still had to take them. LOL

 

LOL indeed, and so prehaps I should clarify my personal opinion somewhat.

Of course, there are alternative combinations without Integrase inhibitors (INIs). However, INIs are common nowadays, first line, and with DTG (Tivicay), it's easy to take with little interaction concerns or side effects generally and certainly not for me. So, had there been a minor or moderate heart concern, I would still opt to take DTG, given the alternatives currently available and my own personal health needs and medical history.

 

[leatherman]

clarify

maybe I should clarify too as I take dolutegravir (tivicay). for myself and quite a number of my friends, INIs are awesome. They work, work well, and with few if any negative side effects. Coming from the early days of ARVs, I'm just of the opinion that even IF meds had negative side effects, I'd take 'em! I've taken a lot of meds that seriously messed me up.....but those super negative side effects were certainly better than death. LOL