Dr. Biao Zhu, First Affiliated Hospital of Zhejiang University School of Medicine
Editor’s Note:
Although antiretroviral therapy (ART) has greatly reduced the mortality associated with HIV, the morbidity of non-AIDS-related complications associated with HIV remains high. Therefore, it is crucial to understand and assess clinical decision factors for adjusting ART in the context of suppressed HIV RNA. At the recently concluded 12th International AIDS Society HIV Science Conference ( IAS 2023), Dr. A. Cozzi-Lepri of University College London reported a study (Abstract number: EPB0169) that analyzed and evaluated the risk of ART switches in the context of common comorbidities combined with HIV and suppressed HIV RNA. This journal specially invited Dr. Biao Zhu from the First Affiliated Hospital of Zhejiang University School of Medicine, China, to provide a brilliant review of this research.
Researchers conducted a cross-sectional analysis of the Icona cohort data, including HIV-infected individuals with virologically stable HIV RNA ≤50 copies/mL. The primary study looked at the influence of four comorbidities (obesity, lipid disorders, kidney disease, and diabetes) on the probability of ART switching. The study included individuals with a viral load (VL) ≤ 50 copies/mL for more than six months; those who switched ART regimens were the test group, and those who maintained the same ART regimen were the control group. A logistic regression model was used to assess the association between comorbidities and the risk of ART switching, and further analysis was done on the specific drugs used.
The study included 9,212 HIV-infected individuals and analyzed a total of 17,109 events. The median age was 48 years (IQR: 39-56 years); 19% were female, 47% were men who had sex with men, and 35% were of foreign nationality. The median CD4 count was 734 (541-954). The morbidity rates for major comorbidities were: obesity 11%, lipid disorders 74%, kidney disease 11%, and diabetes 6%.
The results showed that lipid disorders were associated with an increased risk of ART switching (a 64% increase in the exposed group compared to the unexposed group), obesity was associated with a reduced risk of ART switching (a 26% reduction in risk), and diabetes was negatively correlated with ART switching risk, but this was only observed in patients using integrase inhibitors (INSTIs) or newer generation non-nucleoside reverse transcriptase inhibitors (NNRTIs).
Expert’s Review
This study found that the presence of comorbidities affects the ART regimen and management of HIV patients. Due to the widespread use of newer generation NNRTI or INSTI-based regimens, the risk of ART switching in diabetic patients is decreasing. Moreover, in recent years, the reduced risk of switching in patients with lipid disorders might also be related to the use of treatments considered “lipid-friendly.” These research findings suggest that considering the presence of comorbid factors in HIV-infected individuals is crucial for clinical decisions regarding adjustments to the ART regimen.
