Switching Class Inhibitors Might Save Your Life

Switching from one kind of inhibitor to another to treat your HIV could decrease your risks of developing diabetes, obesity, or heart disease, according to a study published recently in the Journal of Antimicrobial Chemotherapy.

The study participants, who were virally suppressed thanks to antiretroviral regimens that included Truvada (tenofovir disoproxil fumarate/emtricitabine) and a ritonavir-boosted protease inhibitor, were switched instead to regimens with an integrase inhibitor (either raltegravir or dolutegravir) and saw improvement in insulin sensitivity, insulin resistance, and serum leptin levels.

The study involved 86 participants living with HIV, 86 percent of whom were men, with an average age of 45.7 years, who had been on treatment for at least two years and virally suppressed for at least six months. Researchers switched 45 participants to raltegravir and the other 41 to dolutegravir. Both groups experienced a significant decrease in mean leptin/insulin concentration. Lipid levels also decreased with both raltegravir and dolutegravir.

Higher concentrations of both insulin and leptin have been associated with obesity, and higher insulin concentrations can also be a sign of prediabetes. Meanwhile, lipid levels are the levels of fat, also known as cholesterol, in the blood. High cholesterol is associated with heart disease, a condition that people living with HIV are more susceptible to.

Since kidney disease and heart attacks now kill more poz folks than HIV-related illnesses, lowering these levels can be a good reason to switch from a protease to an integrase inhibitor.

Researchers concluded that “the switch from a [protease inhibitor] to raltegravir or dolutegravir proved effective in improving insulin sensitivity, and also reduced certain inflammatory markers and lipid parameters. Further, larger, randomized trials are clearly needed in order to better define the effect of these switch strategies on glucose metabolism in patients with HIV infection.”

Numerous studies have confirmed that it is safe to switch from your current antiretroviral therapy while you are undetectable without risking your viral suppression. If you are having disconcerting side effects or are dealing with a comorbidity (like high cholesterol or liver disease), reevaluating your medications can be a smart choice for your overall health. Talk it over with your doctor to determine which medications may be right for you. A simple switch of medication could reduce your risk of developing what could end up being a life-threatening disease.