Longitudinal analysis of metabolic changes in people with HIV on integrase inhibitor-based versus efavirenz-based therapy: a prospective real-world cohort study in China
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) is recommended for HIV treatment but has been associated with metabolic adverse effects. However, real-world longitudinal data on these metabolic changes remain limited. This study aimed to characterize weight gain, dyslipidemia, and hepatic steatosis in ART-naïve people living with HIV (PLWH) initiating INSTI-based versus efavirenz (EFV)-based therapy. METHODS: This prospective cohort study enrolled 772 participants at Nanfang Hospital, Southern Medical University from 2020 to 2023. Participants were categorized into 3 groups: EFV/tenofovir disoproxil fumarate (TDF)/lamivudine (3TC) (n = 389); elvitegravir/cobicistat (EVG/c)/tenofovir alafenamide (TAF)/emtricitabine (FTC) or bictegravir (BIC)/TAF/FTC (n = 168); and dolutegravir (DTG)/3TC or DTG/3TC/TDF (n = 215). Metabolic parameters-including body mass index (BMI), lipids, and hepatic steatosis assessed via controlled attenuation parameter (CAP)-were evaluated at baseline, 6, 12, and 24 months using generalized estimating equations. RESULTS: At 24 months, INSTI-based regimens were associated with significantly higher BMI compared to EFV/TDF/3TC (all P < 0.001), with no difference between INSTI subtypes. All groups showed early increases in triglycerides (TG) and total cholesterol (TC) that stabilized after 12 months; TG and TC levels at 24 months did not differ significantly between TAF-containing INSTI regimens and other groups. The prevalence of hepatic steatosis (CAP ≥ 238 dB/m) peaked at 31.2% at year 1 and declined to 28.8% at year 2. Multivariate analysis identified higher BMI (OR 1.55, 95% CI 1.44-1.67; p < 0.001), elevated TG (OR 1.44, 95% CI 1.22-1.70; p < 0.001), and elevated LDL-C (OR 1.90, 95% CI 1.21-2.98; p = 0.005) as independent risk factors. CONCLUSION: INSTI-based ART was associated with sustained weight gain but did not worsen long-term dyslipidemia compared to an EFV-based regimen in a real-world setting. Hepatic steatosis correlated with metabolic parameters rather than INSTI exposure.
Source: BMC Infectious Diseases
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,090
OpenAlex ID: W7123599858