Comparative changes of lipid levels in treatment-naive, HIV-1-infected adults treated with dolutegravir vs. efavirenz, raltegravir, and ritonavir-boosted darunavir-based regimens over 48 weeks

Abstract

Background and objectives: Long-term use of antiretroviral therapy (ART) to treat HIV infection has been associated with dyslipidemia and metabolic and cardiovascular complications. Available options for patients at risk of cardiovascular disease include antiretroviral drugs with improved lipid profiles. Dolutegravir is one of a new generation of HIV integrase inhibitors recently incorporated into the US Department of Health and Human Services, German, Spanish, and Italian HIV treatment guidelines as a preferred first-line third agent in combination with dual nucleoside reverse transcriptase inhibitor (NRTI) backbone therapies. To understand the lipid profile of dolutegravir in the context of combination ART, we analyzed the lipid outcomes at 48 weeks in ART-naive participants in four phase IIb-IIIb clinical trials.

Methods: Variables included in this analysis were total cholesterol (TC), low-density lipoprotein (LDL) cholesterol (LDL-C), high-density lipoprotein (HDL) cholesterol (HDL-C), TC/HDL ratio, and triglycerides at baseline and week 48.

Results: In a comparative analysis, dolutegravir demonstrated a broadly neutral effect on lipids versus efavirenz or ritonavir-boosted darunavir; in both comparisons, patients taking dolutegravir exhibited smaller increases in TC, LDL-C, and triglyceride levels. In comparison with raltegravir, dolutegravir exhibited a similar lipid profile, including small increases in TC, LDL-C, and triglyceride levels for both agents. In the pooled dolutegravir analysis, minimal increases in LDL-C and triglycerides were observed but mean values at 48 weeks remained below National Cholesterol Education Program target levels. HDL-C levels increased at 48 weeks, and the mean TC/HDL-C ratio was 0.6 at 48 weeks; these values are associated with a lower risk of cardiovascular disease.

Conclusions: Together, these data show that dolutegravir has a safer lipid profile in combination ART and provides an important treatment option for older patients who may have other risk factors for metabolic syndrome or cardiovascular disease.

Fig. 1

Pooled DTG at baseline and at week 48 a total cholesterol, b LDL cholesterol, c HDL cholesterol, and d triglyceride levels. Boxes represent the first to third quartile; lines and symbols within the box represent medians and means, respectively. Whiskers extend to the most extreme observations within 1.5 times the length of the interquartile range from the first and third quartiles. Points beyond the whiskers are considered outliers. DTG dolutegravir, HDL high-density lipoprotein, LDL low-density lipoprotein

Fig. 2

Changes from baseline total cholesterol at week 48. Boxes represent the first to third quartile; lines and symbols within the box represent medians and means, respectively. Whiskers extend to the most extreme observations within 1.5 times the length of the interquartile range from the first and third quartiles. Points beyond the whiskers are considered outliers. DRV/r darunavir/ritonavir, DTG dolutegravir, EFV efavirenz, EFV/TDF/FTC efavirenz/tenofovir disoproxil fumarate/emtricitabine, RAL raltegravir

Fig. 3

Changes from baseline in a HDL cholesterol, b LDL cholesterol, c triglycerides, and d total cholesterol/HDL ratio at 48 weeks. Boxes represent the first to third quartile; lines and symbols within the box represent medians and means, respectively. Whiskers extend to the most extreme observations within 1.5 times the length of the interquartile range from the first and third quartiles. Points beyond the whiskers are considered outliers. DRV/r darunavir/ritonavir, DTG dolutegravir, EFV efavirenz, EFV/TDF/FTC efavirenz/tenofovir disoproxil fumarate/emtricitabine, HDL high-density lipoprotein, LDL low-density lipoprotein, RAL raltegravir