Integrase Inhibitors Linked to Higher Cardiometabolic Risk in HIV Patients

Study finds switching to integrase inhibitors raises risk of obesity, diabetes, and hypertension in people living with HIV

Apr. 16, 2026 at 12:05pm

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A ghostly, translucent X-ray-style image revealing the internal structure of a human heart and blood vessels in glowing, ethereal lines against a dark background, conceptually representing the cardiovascular health implications of switching HIV medications.An X-ray-like visualization of the cardiovascular system highlights the potential cardiometabolic risks associated with switching HIV medications.Boston Today

A secondary analysis of the REPRIEVE study found that among people living with HIV on stable antiretroviral therapy and with low-to-moderate cardiovascular risk, switching to integrase strand transfer inhibitor (INSTI)-containing regimens increased the risk of developing diabetes by 50% and increased the risk of obesity and hypertension by more than 40% compared to continuing non-INSTI regimens.

Why it matters

This study highlights potential cardiometabolic risks associated with switching to INSTI-based antiretroviral therapy in people living with HIV, which is an important consideration given the widespread use of INSTIs. Long-term monitoring of people with HIV switching to INSTIs will be crucial to manage developing comorbidities and assess future cardiovascular outcomes.

The details

Researchers conducted a secondary analysis of the REPRIEVE study, emulating a series of target trials to assess the impact of switching to an INSTI-containing antiretroviral regimen on cardiometabolic outcomes. A total of 5,114 participants on stable non-INSTI therapy for at least 6 months were eligible, with 2,981 switching to an INSTI-based regimen and 5,059 remaining on non-INSTI therapy. The study found that switchers had a 41% higher risk of developing obesity, a 50% higher risk of developing diabetes, and a 45% higher risk of developing hypertension compared to non-switchers. No significant difference was observed in the risk of major adverse cardiovascular events between the two groups during the 5-year follow-up.

  • The study was published online on March 27, 2026.
  • Participants were considered as switchers if they switched to an INSTI-based regimen between days 0 and 59, and as non-switchers if they did not switch.

The players

Emma M. Kileel

The lead author of the study, from the Boston University School of Public Health.

REPRIEVE study

A clinical trial that provided the data for the secondary analysis conducted in this study.

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What they’re saying

“Although the absolute risk of these outcomes was small, given the elevated risk profile, long-term observation of people with HIV switching to INSTIs will be crucial to ensure appropriate management of developing comorbidities and to assess for future development of MACE.”

— Emma M. Kileel, Lead author

What’s next

Researchers will need to continue monitoring people with HIV who switch to INSTI-based regimens to better understand the long-term cardiometabolic effects and ensure appropriate management of any developing comorbidities.

The takeaway

This study suggests that switching to integrase inhibitor-based antiretroviral therapy in people living with HIV may increase the risk of developing obesity, diabetes, and hypertension, highlighting the importance of close monitoring and management of cardiometabolic health in this population.