Switching to dolutegravir from a protease inhibitor did not increase hypertension incidence in European study

Switching from an antiretroviral regimen containing a protease inhibitor (PI) to one containing the integrase inhibitor dolutegravir (DTG) does not seem to increase hypertension rates in people living with HIV (PLWH) with heightened cardiovascular risk, according to the results of a study conducted in Western Europe.

About This Study

“Incidence of Hypertension and Blood Pressure Changes in Persons With Human Immunodeficiency Virus (HIV) at High Risk for Cardiovascular Disease Switching From Boosted Protease Inhibitors to Dolutegravir” was published online on May 19, 2023, in Clinical Infectious Diseases. The lead authors are Abiu Sempere of the Hospital Clínic-IDIBAPS at the University of Barcelona, Spain, and of CIBER de Enfermedades Infecciosas (CIBERINFEC) of the Instituto de Salud Carlos III in Madrid, Spain, and Lambert Assoumou, Dr.P.H., of the Département d’Epidémiologie at Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique in Paris, France. One study author is from ViiV Healthcare, the manufacturer of dolutegravir.

Key Research Findings

This substudy of the NEAT-022 trial, carried out in 32 clinical sites across six European countries during 2014-2015, investigated hypertension among virally suppressed PLWH with Framingham risk scores (a measure of cardiovascular risk) > 10 who switched from a boosted PI to DTG. Most participants were middle-aged white men (89% men, 85% white, 88% > 50 years old). They were randomized 1:1 to swap their PI for DTG immediately or to wait until week 48 to switch. At baseline, 46% of the 412 participants had hypertension and 26% of participants were taking blood pressure medications, including 24 participants with indications other than hypertension.

Of the 197 participants without hypertension or anti-hypertensives at baseline, 56 people developed high blood pressure by week 48; 29 participants in the delayed-switch arm and 27 participants in the immediate-switch arm. Between weeks 48 and 96, 45 additional participants developed hypertension–19 in the immediate-switch arm and 26 in the delayed-switch arm. While diastolic blood pressure rose during the first 48 weeks on DTG in either arm, the range of increases remained below the clinically relevant threshold of 10 mmHg.

Discussion Highlights and Implications for Practice

Study authors stated that their limitations included a lack of demographic diversity and the fact that, in practice, few people are switched to DTG from a PI-based regimen. The participants also had a high baseline risk for cardiovascular disease that may not apply to other PLWH.

Larger studies are needed, the authors wrote, but their findings nonetheless suggest that changing to DTG from a PI does not appear to increase the incidence of hypertension in PLWH with heightened cardiovascular risk. The overall incidence in high blood pressure underscores the importance of hypertension management in PLWH, especially as they age, they noted.

By Barbara Jungwirth