INSTIs Are Associated With Increased Incidence of Hypertension, Other ARTs Are Not

Hypertension is significantly more likely to develop among patients taking medications from the integrase strand inhibitor (INSTI) group than in the nonnucleoside reverse transcriptase inhibitor (NNRTI) group, according to data presented at IDWeek 2021.

To compare the effects of INSTIs with those of NNRTIs or protease inhibitors (PIs) on the development of metabolic comorbidities in patients with HIV in the Illinois Department of Corrections, researchers from the University of Illinois at Chicago retrospectively studied 206 incarcerated adults with HIV who received a guideline-recommended antiretroviral therapy (ART) between July 12, 2010, and December 31, 2019. Most patients were Black (69%) and male (91%).

The primary outcome was the incidence of metabolic comorbidity adjusted for age, race, use of antipsychotic medications, and family history of metabolic comorbidities.  Secondary outcomes included incidence of weight gain, diabetes, hypertension, and hyperlipidemia by drug class. Patients with a diagnosis of diabetes, hypertension, or hyperlipidemia were excluded, demographics and relevant laboratory data were collected, and the data was analyzed using ANOVA, chi-squared, and paired t-tests.

During a mean follow-up of 31.5 months, a metabolic comorbidity developed in 42 of the 206 patients (20%). After the researchers adjusted for confounding factors, they found that a comorbidity was more likely to develop in those in the group who received INSTIs than in those who received NNRTIs (p = 0.004). In contrast, no difference in this propensity was noted between the INSTI group and the PI group. 

Hypertension was significantly more likely to develop in the INSTI group than in the NNRTI group (p = 0.01), but diabetes and hyperlipidemia were not.

“All antiretrovirals were linked to weight gain, but INSTIs were associated with increased incidence of hypertension,” noted presenting author Niha Idrees, PharmD.

—Ellen Kurek


Idrees N, Hwang UJ, Arman S. Evaluation of the incidence of hypertension, diabetes, and hyperlipidemia in patients on antiretroviral therapy. Paper presented at: IDWeek 2021; September 29-October 3, 2021; Virtual.