Immunological Effects of Integrase Inhibitors versus Protease and Non-Nucleoside Reverse Transcriptase Inhibitors as Part of Initial Therapy in People Living with HIV. A Systematic Review

• Published in: Iatreia (Medellín, Colombia) Colombia), 2024-07, Vol.37 (3), p.354-366
• Main Authors: Melissa Gutiérrez-Gómez, Sofía Giraldo-Hoyos, Salomón Gallego-Quintero, Natalia Taborda-Vanegas, María Teresa Rugeles-López, Juan Carlos Alzate-Ángel
• Format: Article
• Language: Spanish
• Subjects: antiretroviral therapy; highly active; hiv integrase inhibitors; immune reconstitution; systematic review
• ISSN: 0121-0793; 2011-7965
• DOI: 10.17533/udea.iatreia.255

Introduction: The use of integrase inhibitors within highly active antiretroviral therapy (HAART) has demonstrated benefits for individuals living with HIV. However, most comparisons are based on effectiveness against viral replication, with limited information on their impact on the immune system. Objective: To identify immunological outcomes in studies comparing in- tegrase inhibitors (INSTIs) with other drugs used as third agents in HAART. Methods: Systematic review of studies reporting patients treated with INS- TIs versus non-nucleoside reverse transcriptase inhibitors (NNRTIs) or pro-tease inhibitors (PIs) as the third drug in HAART. Immunological reconstitution outcomes were assessed, including CD4+ T lymphocyte count, CD4/ CD8 ratio, serum concentration of sCD14, D-dimer, and C-reactive protein, as well as the frequency and phenotype of T cells, functional capacity of T cells, and proviral DNA. Results: A total of 2804 studies were screened, 59 were evaluated in full text and four were included in the synthesis. A cohort study reported normalization of the CD4/CD8 ratio in patients initiating treatment with INSTIs compared to PIs or NNRTIs. However, this finding was not consistently replicated in other studies, and in one of them, this ratio was higher in those receiving efavirenz vs. dolutegravir. No evidence was found for other outcomes. Conclusions: The analyzed studies are inconclusive regarding differences in immunological reconstitution between INSTIs vs. PIs and NNRTIs.