ArticleThe lancet. HIV2023
Integrase strand-transfer inhibitor use and cardiovascular events in adults with HIV: an emulation of target trials in the HIV-CAUSAL Collaboration and the Antiretroviral Therapy Cohort Collaboration.
Article in The lancet. HIV, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed, 29 citations in OpenAlex.
- The effect of hypothetical interventions to limit weight gain on incident type 2 diabetes mellitus among people with HIV initiating antiretroviral therapy in the United States, 2012-2021.American journal of epidemiology · 2026Article
- Host Genetic Regulation of NLRP3 Inflammasome Cytokines Reveals Immune and Vascular Pathways in HIV.medRxiv : the preprint server for health sciences · 2026Article
- Switching to Integrase Inhibitors and Cardiovascular Disease Risk in Treatment-Experienced People With HIV: A Sequential Target Trial Emulation in the Swiss HIV Cohort Study.Open forum infectious diseases · 2026Article
- Cardiovascular Disease Risk with Integrase Inhibitor-based Antiretroviral Therapy: A Causal Inference Analysis in RESPOND.Open forum infectious diseases · 2026Article
- Risk of Major Adverse Cardiovascular Events With Dolutegravir Versus Efavirenz-Based Antiretroviral Therapy: Emulated Target Trials Using Routine, De-identified Data From South Africa.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- Incident diabetes after switching to integrase strand transfer inhibitors in people with HIV in the USA and Canada: a cohort study.The lancet. HIV · 2026Article
- Risk of obesity, diabetes, hypertension, and major adverse cardiovascular events after a switch to an integrase inhibitor: a target trial emulation in REPRIEVE.The lancet. HIV · 2026Article
- Pharmacovigilance study of INSTIs associated with weight gain and glucose/lipid metabolism adverse events based on the FDA adverse event reporting system.HIV medicine · 2026Article
- Design and Implementation of Observational Studies Emulating a Target Trial.JAMA network open · 2026Article
- Impact of integrase strand transfer inhibitors on cardiovascular disease in people with HIV.Annals of epidemiology · 2026Article
- Molecular insights in HIV-associated cardiac dysfunction.Communications medicine · 2025Article
- Association between transitioning to a dolutegravir-based regimen and risk of incident hypertension in adults with HIV in West Africa: a multicentre target trial emulation study.EClinicalMedicine · 2025Article
- People Living with HIV in Japan Exhibit Situation-Specific Optimism Regarding the Progression to Acquired Immunodeficiency Syndrome (AIDS).AIDS and behavior · 2025Article
- Causal estimation of time-varying treatments in observational studies: a scoping review of methods, applications, and missing data practices.BMC medical research methodology · 2025Article
- Greater Accumulation of Brain White Matter Hyperintensities in People Diagnosed and Treated During Acute HIV Compared With People Without HIV.Neurology · 2025Article
- No accelerated progression of subclinical atherosclerosis with integrase strand transfer inhibitors compared to non-nucleoside reverse transcriptase inhibitors.The Journal of antimicrobial chemotherapy · 2025Article
- Changes in Atherosclerotic Cardiovascular Disease Risk Scores in a Predominantly Black Cohort with HIV and Associated Comorbidities: A Preliminary Study.Cardiology · 2025Article
- Exercise to Prevent Accelerated Vascular Aging in People Living With HIV.Circulation research · 2024Review
- Observational
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31 authors at 20 institutions in 9 countries.
Funding
Abstract
backgroundA recent observational study suggested that the risk of cardiovascular events could be higher among antiretroviral therapy (ART)-naive individuals with HIV who receive integrase strand-transfer inhibitor (INSTI)-based ART than among those who receive other ART regimens. We aimed to emulate target trials separately in ART-naive and ART-experienced individuals with HIV to examine the effect of using INSTI-based regimens versus other ART regimens on the 4-year risk of cardiovascular events.
methodsWe used routinely recorded clinical data from 12 cohorts that collected information on cardiovascular events, BMI, and blood pressure from two international consortia of cohorts of people with HIV from Europe and North America. For the target trial in individuals who had previously never used ART (ie, ART-naive), eligibility criteria were aged 18 years or older, a detectable HIV-RNA measurement while ART-naive (>50 copies per mL), and no history of a cardiovascular event or cancer. Eligibility criteria for the target trial in those with previous use of non-INSTI-based ART (ie, ART-experienced) were the same except that individuals had to have been on at least one non-INSTI-based ART regimen and be virally suppressed (≤50 copies per mL). We assessed eligibility for both trials for each person-month between January, 2013, and January, 2023, and assigned individuals to the treatment strategy that was compatible with their data. We estimated the standardised 4-year risks of cardiovascular events (myocardial infarction, stroke, or invasive cardiovascular procedure) via pooled logistic regression models adjusting for time and baseline covariates. In per-protocol analyses, we censored individuals if they deviated from their assigned treatment strategy for more than 2 months and weighted uncensored individuals by the inverse of their time-varying probability of remaining uncensored. The denominator of the weight was estimated via a pooled logistic model that included baseline and time-varying covariates.
findingsThe analysis in ART-naive individuals included 10 767 INSTI initiators and 8292 non-initiators of INSTI. There were 43 cardiovascular events in INSTI initiators (median follow-up of 29 months; IQR 15-45) and 52 in non-initiators (39 months; 18-47): standardised 4-year risks were 0·76% (95% CI 0·51 to 1·04) in INSTI initiators and 0·75% (0·54 to 0·98) in non-INSTI initiators; risk ratio 1·01 (0·57 to 1·57); risk difference 0·0089% (-0·43 to 0·36). The analysis in ART-experienced individuals included 7875 INSTI initiators and 373 965 non-initiators. There were 56 events in INSTI initiators (median follow-up 18 months; IQR 9-29) and 3103 events (808 unique) in non-INSTI initiators (26 months; 15-37) in non-initiators: standardised 4-year risks 1·41% (95% CI 0·88 to 2·03) in INSTI initiators and 1·48% (1·28 to 1·71) in non-initiators; risk ratio 0·95 (0·60 to 1·36); risk difference -0·068% (-0·60 to 0·52).
interpretationWe estimated that INSTI use did not result in a clinically meaningful increase of cardiovascular events in ART-naive and ART-experienced individuals with HIV.
fundingNational Institute of Allergy and Infectious Diseases and National Institute on Alcohol Abuse and Alcoholism.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.