The effect of switching protease inhibitors to raltegravir on endothelial function, in HIV-infected patients

ObjectiveLipid management is one of the cornerstones of cardiovascular risk reduction. Treatment of HIV infection with protease inhibitors (PIs) may cause dyslipidaemia, whilst the integrase inhibitor raltegravir (RAL) has a relatively favorable effect on plasma lipids. We examined the effect of switching from PIs to RAL on endothelial function, and its effect on immunological and inflammatory parameters.MethodsWe performed a 16-week open-label prospective crossover study: 8 weeks intervention (switch PIs to RAL) and 8 weeks control (unchanged cART regimen). Flow-mediated dilatation (FMD), inflammatory plasma, and cellular markers of immune activation were measured at weeks 0, 8, and 16.ResultsStudy participants (n = 22) with a median age of 50 years (IQR 42–60) and known HIV infection of 6.5 years (IQR 5.0–17.3) were on stable cART with undetectable HIV viral loads. After 8 weeks of RAL therapy, a reduction in FMD of −0.81% was seen, compared to +0.54% control (pairwise, p = 0.051), while fasting total c...