Metabolic Effects of HIV Protease and Integrase Inhibitors

There are many effective options for treating HIV infection, and the field is now largely focused on avoiding toxicities. In ACTG A5257, the researchers compared three regimens for initial treatment — raltegravir, atazanavir/ritonavir, and darunavir/ritonavir — each in combination with tenofovir/FTC. Although virologic efficacy was similar among the regimens (NEJM JW Infect Dis Nov 2014 and Ann Intern Med 2014; 161:461), overall outcomes were best in the raltegravir group, largely because of the drug's excellent tolerability. Now, the researchers have examined the metabolic effects of these regimens.

A total of 1797 participants were included in the current analysis. At the time of study entry, 21% had evidence of metabolic syndrome. Partici…