Cardiometabolic Disease Risk Assessment of HIV Medication Regimens

Objective: To determine the effect of non-nucleoside reverse transcriptase inhibitor (NNRTI) or integrase strand transfer inhibitor (IIh) based regimens on cardiovascular and metabolic disease risk in HIV +ve patients without diabetes, with normal CD4:CD8 count. Our goal was to use hematopoietic progenitor cells (CD34+ve) as the biomarker while examining the traditional serum markers. Methods: 21 male subjects ages 32-66 years with BMI 21.0- 36.0, were enrolled. This was a single time point analysis study. Subjects were stratified into 2 groups (IIh with 11 and NNRTI with 10 subjects) who were taking stable doses of HAART. The medication regimens were a combination of two NRTI (typically tenofovir-emtricitabine) plus one IIh or NNRTI. We used CD34+ve cells, arterial stiffness measures and serum for the analysis. Results: The IIh group had a higher average CD34+ve cell count 0.93% vs. 0.75% in NNRTI group. However, colony forming units (CFU) were lower in IIh group, 7.54 vs. 20.62. LDL levels were similar at 103.9 ±40.3 (IIh) vs. 107.8 ±37.5 (NNRTI). Average HDL were also similar. Inflammatory markers such as hs-CRP were lower in IIh at 1.726±1.45 vs. 1.832±1.50 in NNRTI group. Vitals such as average systolic BP in the IIh arm was 126.18±13.53 vs. 141.2±30.0 in NNRTI group. The diastolic BP averages were similar. The average augmentation index-75 (a measure of arterial stiffness) was avg.12.8 in IIh vs. 16.7 in NNRTI group. The average augmentation index (AI) were 15.2 in IIh vs. 20.2 in NNRTI group, with higher values indicating increased arterial stiffness. Average urinary albumin: creatinine ratio was 15.53 in IIh group vs. 76.72 in NNRTI group. No differences were noted in HbA1C, Leptin and adiponectin however average fasting insulin was 11.24 (IIh) vs. 22.96 (NNRTI). No significant differences were noted in CD34+ve cell gene expression assays. Conclusion: Considering all parameters we conclude that Integrase Inhibitor based regimens may have a better cardiometabolic disease risk profile compared to NNRTI based regimens. Disclosure A. Elzarki: None. S. Nandula: None. H. Awal: None. S. Sen: None. Funding District of Columbia Center for AIDS Research (to S.S.)