Journal Article

P22 Glucose homeostasis in people living with HIV starting long-acting antiretroviral therapy

Cretella, S, Rigamonti, C, Marzolla, D, Calza, L, Zuppiroli, A, Viale, P, Giglia, M

2025

Overview

IntroductionInsulin resistance in people living with HIV (PLWH) has become a growing concern. While modern antiretroviral therapy (ART) has reduced HIV-related morbidity and mortality, its effects on metabolic health remain critical.MethodsA retrospective cohort study was conducted with outpatients at our clinic who initiated long-acting cabotegravir/rilpivirine (LA CAB/RPV) between January 2023 and December 2024. The study aimed to evaluate changes in glucose homeostasis after 32 weeks of treatment. Participants were assessed at baseline (T0) and after 32 weeks on ART (T1). Clinical and metabolic parameters were compared to identify significant changes over time.ResultsForty-six participants were included, with a median age of 50 years (IQR 40.5–56.8), and 82.6% were male. At baseline, the cohort had a median BMI of 24.5 (IQR 22.2–26.1) and waist circumference of 90.2 cm (IQR 88.0–96.4). The prevalence of insulin resistance was 28.2%, while 36.9% had dyslipidemia. Baseline glucose was 84.9 mg/dL (IQR 77.0–91.3), median insulin was 8.8 µU/mL (IQR 5.1–11.3), and HOMA index was 1.9 (IQR 1.0–2.7). Previous treatments included mainly integrase inhibitors, with 3TC/DTG (28.2%) and TAF/FTC/BIC (15.2%) being most common.After 32 weeks on long-acting ART, body weight remained stable (75.5 kg at both T0 and T1), and BMI increased modestly from 24.5 to 24.7 (p>0.05). Waist circumference decreased slightly by 0.3 cm (p>0.05). Glycemia increased by 2.2 mg/dL (from 84.9 to 87.1 mg/dL), and insulin levels rose by 1.4 µU/mL (from 8.8 to 10.2 µU/mL), with a marginal increase in the HOMA index of 0.4 (p>0.05). The prevalence of insulin resistance remained unchanged at 28.2%.Lipid metabolism showed slight increases in total cholesterol (+9.3 mg/dL) and LDL (+7.5 mg/dL), while HDL decreased slightly by 0.5 mg/dL (p>0.05). Triglycerides decreased by 2.9 mg/dL (p>0.05). Additionally, 13.0% of participants experienced a weight gain >5%. Renal function showed no significant changes.Immune function remained stable, with CD4+ count decreasing slightly from 824.5 to 809 cells/mm³, and the CD4+/CD8+ ratio improved from 1.09 to 1.92. Viral suppression was robust, with 100% of participants maintaining HIV RNA <50 copies/mL.ConclusionIn our cohort, the switch to long-acting ART with cabotegravir and rilpivirine every 8 weeks led to a slight increase in insulin levels and HOMA-IR index, and these changes did not reach a statistical significance. Importantly, no significant alterations were found in body weight, glucose, or lipid parameters, and immunological and virological efficacy were preserved. These findings highlight the need for further research to explore the long-term effects of ART on glucose homeostasis and to determine optimal management strategies for potential metabolic changes.

• Publisher: BMJ Publishing Group LTD
• Subject: Antiretroviral drugs / Drug therapy / Glucose / HIV / Homeostasis / Human immunodeficiency virus / Insulin resistance / Metabolism