Integrase Strand Transfer Inhibitors are associated with lower risk of incident Cardiovascular Disease in People Living with HIV.

BACKGROUND: Several antiretroviral therapy (ART) classes have been associated with increased myocardial infarction (MI) risk. Cardiovascular disease (CVD) in people living with HIV (PLWH) on integrase strand transfer inhibitors (INSTI) has not been examined. Here we aim to examine this. SETTING: Retrospective cohort design study METHODS:: We used the IBM(R)MarketScan(R) databases for U.S. commercially insured and Medicaid covered adults to identify PLWH newly initiated on ART between Jan 1, 2008 and Dec 30, 2015. Major adverse cardiac event (MACE), a composite of acute MI, ischemic stroke, coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), was the primary outcome. We used calendar-time specific probability-weighted Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between INSTI use and MACE. We used propensity score weighting methods to account for potential confounding. RESULTS: 20,242 new ART initiators were identified. 5,069 (25%) PLWH initiated INSTI-based regimens. 203 MACE events occurred; acute MI 16 (0.32%) vs 66 (0.43%), stroke 24 (0.47%) vs 54 (0.36), CABG 2 (0.04%) vs 9 (0.06%), PCI 7 (0.14%) vs 25 (0.16%) of INSTI users vs non-users. INSTI-based ART was associated with significantly lower risk of MACE events (HR 0.79; 95% CI 0.64, 0.96) compared to non-INSTI-based regimens. CONCLUSION: In this cohort, INSTI-based regimens were associated with a 21% decreased risk of incident CVD. These finding require validation in other cohorts and with longer follow up.