Switching from boosted PIs to dolutegravir in HIV-infected patients with high cardiovascular risk: 48 week effects on subclinical cardiovascular disease.

Abstract

BACKGROUND:

Switching from boosted PIs to dolutegravir in virologically suppressed HIV-infected patients with high cardiovascular risk significantly decreased total cholesterol and other proatherogenic lipid fractions at 48 weeks. The impact of this strategy on subclinical cardiovascular disease is unknown.

METHODS:

NEAT022 is a European, multicentre, open-label, randomized, non-inferiority trial. HIV-infected adults aged >50 years or with a Framingham score >10% were eligible if plasma HIV RNA was <50 copies/mL for >24 weeks on a boosted PI-based regimen. Patients were randomized 1:1 to switch from boosted PIs to dolutegravir or to continue on boosted PIs. Common carotid arteries intima-media thickness (CIMT) and pulse wave velocity (PWV) were measured following a standardized protocol in a subgroup of NEAT022 study participants at baseline and at Week 48.

RESULTS:

One hundred and fifty-six patients participated in the ultrasonography and arterial stiffness substudies, respectively. In each substudy, population characteristics did not differ between arms and matched those of the main study. At 48 weeks, patients who switched to dolutegravir had lower mean progression of both right (+4 versus +14.6 μm) and left (-6.1 versus +1.6 μm) CIMT and also a smaller increase in mean PWV (+0.18 versus +0.39 m/s) than patients continuing on boosted PIs, although differences were not statistically significant. CIMT trends were consistent across Framingham score, age and country. Inconsistent effects were seen in arterial stiffness.

CONCLUSIONS:

Relative to continuing on boosted PIs, switching to dolutegravir in virologically suppressed patients with high cardiovascular risk showed consistent favourable although non-significant trends on CIMT progression at 48 weeks.

• Authors: Ana Gonzalez-Cordon, Lambert Assoumou, Miguel Camafort, Monica Domenech, Giovanni Guaraldi, Pere Domingo, Stefano Rusconi, François Raffi, Christine Katlama, Mar Masia, Jose I Bernardino, Maria Saumoy, Anton Pozniak, Jose M Gatell, Esteban Martinez, NEAT022 Study Group
• Journal: The Journal of antimicrobial chemotherapy (J Antimicrob Chemother) Vol. 75 Issue 11 Pg. 3334-3343 (11 01 2020) ISSN: 1460-2091 [Electronic] England
• PMID: 32737482 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: [email protected].

Chemical References

• Anti-HIV Agents
• Heterocyclic Compounds, 3-Ring
• Oxazines
• Piperazines
• Pyridones
• dolutegravir

Topics

• Adult
• Anti-HIV Agents (adverse effects)
• Cardiovascular Diseases
• Carotid Intima-Media Thickness
• HIV Infections (complications, drug therapy)
• Heart Disease Risk Factors
• Heterocyclic Compounds, 3-Ring
• Humans
• Oxazines
• Piperazines
• Pulse Wave Analysis
• Pyridones
• Risk Factors
• Viral Load