Improving The Lives Of HIV Patients
happen whether they are switched to integrase inhibitors from another HIV regimen (treatment experienced) or whether they are started on an integrase inhibitor-containing regimen as their very first HIV regimen. The integrase inhibitors in use are Raltegravir (the first integrase approved for use in 2007), Elvitegravir (included in combinations Genvoya and Stribild), Dolutegravir (included in combinations Triumeq and Juluca) and Bictegravir (included in the combination Bictarvy).
The integrase inhibitors are currently the most powerful drugs we have in suppressing HIV infection and they became recommended as first-line agents because of their tolerability and their low-side effect profile, or so we thought.
The reason I subtitled this section “Déjà vu” relates to what happened to the HIV treatment community about 20 years ago. We were celebrating the availability of the protease inhibitor drugs which allowed us to suppress patients to undetectable levels of virus when combined with other drugs.
The problem was that the older drugs in this class had many side-effects and required multiple doses. Using drugs like Indinavir, Nelfinavir and later, Lopinavir (Kaletra), we soon began to see changes in our patients’ body composition. Most disturbing was abnormal fat distribution where patients would accumulate weight in the belly (visceral adiposity) and in the back of the neck (“buffalo hump”), at the same time losing fat in the limbs and the face (termed lipoatrophy).
We later learned that loss of fat was likely due to drugs in the nucleoside class like