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Standard Integrase Regimens Have Minimal Glucose Impact in Older Black Women
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International Workshop on HIV and Aging, October 13-14, 2022
By Mark Mascolini for NATAP and Virology Education
In a largely African-American group of women 50 or older, starting the integrase inhibitor bictegravir (plus emtricitabine/tenofovir alafenamide, B/F/TAF) or dolutegravir (plus lamivudine, DTG/3TC) had little impact on serum glucose through 48 weeks [1]. In this small retrospective review in the southeastern United States, women with a history of type 2 diabetes and women taking DTG has bigger glucose gains, but study group numbers were too small to determine whether those differences were statistically significant.
Clinical researchers at Midway Specialty Care Centers in a half-dozen Florida cities reminded colleagues that metabolic changes like altered glucose metabolism and insulin resistance frequently develop in people with HIV, especially older people who have taken antiretrovirals longer and have non-HIV risk factors for metabolic problems. Much clinical research links HIV integrase inhibitors to weight gain and metabolic changes.
To explore these issues in a real-world clinic population of HIV-positive women 50 or older, the Midway collaborators assessed changes in fasting serum glucose after 48 weeks of B/F/TAF (33 women) or DTG/3TC (6 women). All study participants were cisgender women.
Median age of these 39 women stood at 62.6 (range 50 to 81); 74% were black, 18% white, and 8% Hispanic. Fourteen women (36%) had a history of type 2 diabetes. Pretreatment viral load averaged 11,409 copies (range less than 20 to 226,000) and pretreatment CD4 count 668 (range 58 to 1369). Baseline serum glucose averaged 113 mg/dL (range 71 to 351). (Normal serum glucose is 70 to 100 mg/dL, or 3.9 to 5.6 mmol/L.) All women had an HIV load below 200 copies at treatment week 48.
After 48 weeks of integrase inhibitor therapy, median serum glucose edged up 3 mg/dL in these 39 women. Median change was also 3 mg/dL in the 33 women taking B/F/TAF, in the 29 black women studied, and in the 25 with no history of type 2 diabetes. Median fasting glucose rose 8 mg/dL in the 6 women taking DTG/3TC and the 14 with a history of type 2 diabetes.
The clinical researchers concluded that for aging women B/F/TAF and DTG/3TC are antiretroviral options that can achieve viral suppression without seriously affecting serum glucose.
References
1. Kuretski J, Ramgopal M, Azemar A, et al. Glucose changes among aging female PWH in southeast United States. International Workshop on HIV and Aging, October 13-14, 2022. Abstract 26.
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