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Shengir M, Lebouche B, Elgretli W, Saeed S, Ramanakumar AV, Giannakis A, De Pokomandy A, Cox J, Costiniuk C, Routy JP, Klein MB, Sebastiani G. Switch to a raltegravir-based antiretroviral regimen in people with HIV and non-alcoholic fatty liver disease: A randomized controlled trial. HIV Med 2024; 25:135-142. [PMID: 37641534 DOI: 10.1111/hiv.13531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/01/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION The effect of antiretroviral therapy (ART), particularly integrase strand transfer inhibitors (INSTIs), on non-alcoholic fatty liver disease (NAFLD) in people with HIV remains unclear. We evaluated the effect of switching non-INSTI backbone antiretroviral medications to raltegravir on NAFLD and metabolic parameters. MATERIALS AND METHODS This was a single-centre, phase IV, open-label, randomized controlled clinical trial. People living with HIV with NAFLD and undetectable viral load while receiving a non-INSTI were randomized 1:1 to the switch arm (raltegravir 400 mg twice daily) or the control arm (continuing ART regimens not containing INSTI). NAFLD was defined as hepatic steatosis by controlled attenuation parameter ≥238 dB/m in the absence of significant alcohol use and viral hepatitis co-infections. Cytokeratin 18 was used as a biomarker of non-alcoholic steatohepatitis. Changes over time in outcomes were quantified as standardized mean differences (SMDs), and a generalized linear mixed model was used to compare outcomes between study arms. RESULTS A total of 31 people with HIV (mean age 54 years, 74% male) were randomized and followed for 24 months. Hepatic steatosis improved between baseline and end of follow-up in both the switch (SMD -43.4 dB/m) and the control arm (-26.6 dB/m); the difference between arms was not significant. At the end of follow-up, aspartate aminotransferase significantly decreased in the switch arm compared with the control arm (SMD -9.4 vs. 5.5 IU/L). No changes in cytokeratin 18, body mass index, or lipids were observed between study arms. DISCUSSION Switching to a raltegravir-based regimen improved aspartate aminotransferase but seemed to have no effect on NAFLD, body weight, and lipids compared with remaining on any other ART.
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Affiliation(s)
- Mohamed Shengir
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Bertrand Lebouche
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Wesal Elgretli
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Sahar Saeed
- Queen's University, Kingston, Ontario, Canada
| | | | - Andreas Giannakis
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Alexandra De Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Joseph Cox
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Cecilia Costiniuk
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jean-Pierre Routy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marina B Klein
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Giada Sebastiani
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
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Walmsley S, Clarke R, Lee T, Singer J, Cheung AM, Smaill F, De Pokomandy A, Trottier S, Messina E, Guaraldi G. BEING: Bone Health in Aging Women with HIV: Impact of Switching Antiretroviral Therapy on Bone Mineral Density During the Perimenopausal Period. AIDS Res Hum Retroviruses 2023; 39:204-210. [PMID: 36511389 DOI: 10.1089/aid.2022.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Menopause is a high-risk period for osteoporosis, which may be exacerbated by HIV and/or antiretroviral therapy (ART). Our goal was to study the impact of switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) on bone mineral density (BMD) in peri- and early postmenopausal women living with HIV. This is a randomized international multicenter study of an early versus delayed (48-week) switch. BMD was measured by dual energy X-ray absorptiometry scan. Thirty-four women were enrolled: 19 in the immediate and 15 in the delayed switch arm from September 2017 to April 2019; 30 completed the 96-week protocol. The study closed for futility during the COVID-19 pandemic. The median (intraquartile range [IQR]) age was 51 years (47, 53), with a median (IQR) of 16.5 years (14, 23) since HIV diagnosis, median (IQR) 14 years (11, 20) of ART, and mean 8.6 years TDF. At enrollment, TDF was used in combination with a boosted protease inhibitor (n = 7), a non-nucleoside reverse transcriptase inhibitor (n = 13), an integrase inhibitor (n = 11), or more than one ART class (n = 3). The median (95% confidence interval [CI]) percentage change in BMD at the lumbar spine from 0 to 48 weeks in the immediate switch group was 1.97% (-1.15 to 5.49) compared with a median (95% CI) decrease of 2.32% (-5.11 to 0.19) in the delayed arm. The median (95% CI) percentage change in BMD from 0 to 96 weeks was 2.33% (0-4.51) in the immediate arm compared with 0.70% (-3.19 to 2.47) in the delayed arm. We demonstrated a trend to increased BMD at the lumbar spine after a switch from TDF to TAF in peri- and early postmenopausal women living with HIV. Clinical Trials.gov: NCT02815566.
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Affiliation(s)
- Sharon Walmsley
- University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Terry Lee
- Canadian HIV Trials Network, Vancouver, Canada
| | - Joel Singer
- Canadian HIV Trials Network, Vancouver, Canada
| | - Angela M Cheung
- University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Fiona Smaill
- Department of Lab Sciences, Mc Master University, Hamilton, Canada.,Hamilton Health Sciences, Hamilton, Canada
| | | | - Sylvia Trottier
- Department of Medicine, CHU de Québec-Université Laval, Quebec, Canada
| | - Emanuela Messina
- Department of Infectious Diseases, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Giovanni Guaraldi
- Department of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
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Côté J, Cossette S, Ramirez-Garcia P, De Pokomandy A, Worthington C, Gagnon MP, Auger P, Boudreau F, Miranda J, Guéhéneuc YG, Tremblay C. Evaluation of a Web-based tailored intervention (TAVIE en santé) to support people living with HIV in the adoption of health promoting behaviours: an online randomized controlled trial protocol. BMC Public Health 2015; 15:1042. [PMID: 26458508 PMCID: PMC4603806 DOI: 10.1186/s12889-015-2310-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 09/22/2015] [Indexed: 11/19/2022] Open
Abstract
Background Long-term use of antiretroviral therapy, normal aging, and presence of certain risk factors are associated with metabolic disorders that predispose persons living with HIV to diabetes and cardiovascular diseases. The emergence and progression of these disorders can be prevented by adopting healthy behaviours. Based on the theory of planned behaviour, the Web-based tailored intervention TAVIE en santé was developed. The aim of this study is to evaluate the effectiveness of TAVIE en santé in order to support people living with HIV in the adoption of health promoting behaviours. Methods/Design An online randomized controlled trial with parallel-groups will be conducted across Canada. To participate in this study, people living with HIV must be: ≥ 18 years, able to read/understand French or English, have access to the Internet. A convenience sample of 750 participants will be randomly assigned either to an experimental group (TAVIE en santé, n = 375) or to a control group (websites, n = 375) (1:1 allocation ratio). The TAVIE en santé intervention is composed of seven interactive computer sessions, lasting between 5 and 10 min. The sessions, hosted by a virtual nurse, aim to develop and strengthen skills required for behaviour change. The control group will receive a validated list of five predetermined conventional health-related Websites. The adoption of health behaviour (smoking cessation or physical activity or healthy eating) is the principal outcome. Cognitions (intention, attitude, perceived behavioral control) are the secondary outcomes. Health indicators will also be assessed. All outcomes will be measured with a self-administered online questionnaire and collected three times: at baseline, 3 and 6 months after. The principal analyses will focus on differences between the two trial groups using Intention-to-Treat analysis. Discussion This study will yield new results about the efficacy of Web-based tailored health behaviours change interventions in the context of chronic disease. The TAVIE en santé intervention could constitute an accessible complementary service in support of existing specialized services to support people living with HIV adopt health behaviors. Trial registration NCT02378766, assigned on March 3th 2015.
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Affiliation(s)
- José Côté
- Research Centre of the Centre Hospitalier de l'Université de Montréal, 900 Saint Denis Street, Montreal, H2X 0A9, QC, Canada. .,Research Chair in Innovative Nursing Practices, 900 Saint Denis Street, Montreal, H2X 0A9, QC, Canada. .,Faculty of Nursing, Université de Montréal, 2375, chemin de la Côte-Ste-Catherine, Montréal, H3T 1A8, QC, Canada.
| | - Sylvie Cossette
- Faculty of Nursing, Université de Montréal, 2375, chemin de la Côte-Ste-Catherine, Montréal, H3T 1A8, QC, Canada. .,Research Center of the Montreal Heart Institute, 5000, Bélanger Street, Montréal, H1T 1C8, QC, Canada.
| | - Pilar Ramirez-Garcia
- Faculty of Nursing, Université de Montréal, 2375, chemin de la Côte-Ste-Catherine, Montréal, H3T 1A8, QC, Canada.
| | - Alexandra De Pokomandy
- Faculty of Medecine, McGill University, 3655 Sir William Osler, Montreal, H3G 1Y6, QC, Canada.
| | - Catherine Worthington
- Faculty of Human and Social Development, University of Victoria, 3800 Finnerty Road, Victoria, V8P 5C2, BC, Canada.
| | - Marie-Pierre Gagnon
- Research Centre of the Centre Hospitalier Universitaire de Québec, 2705, boulevard Laurier, Québec, G1V 4G2, QC, Canada. .,Faculty of Nursing Sciences, Université Laval, 1050, avenue de la Médecine Local 3645, Québec, G1V 0A6, QC, Canada.
| | - Patricia Auger
- Research Centre of the Centre Hospitalier de l'Université de Montréal, 900 Saint Denis Street, Montreal, H2X 0A9, QC, Canada. .,Research Chair in Innovative Nursing Practices, 900 Saint Denis Street, Montreal, H2X 0A9, QC, Canada.
| | - François Boudreau
- Faculty of Nursing, Université du Québec à Trois-Rivièves, 3351, boul. des Forges, CP 500, Trois-Rivières, G9A 5H7, QC, Canada.
| | - Joyal Miranda
- Ryerson University, 350 Victoria Street, Toronto, M5B 2K3, ON, Canada.
| | - Yann-Gaël Guéhéneuc
- Canada Research Chair on Software Patterns and Patterns of Software, 2500, chemin de Polytechnique, Montréal, H3T 1J4, QC, Canada. .,Department of Computer Engineering, Polytechnique Montréal, 2500, chemin de Polytechnique, Montréal, H3T 1J4, QC, Canada.
| | - Cécile Tremblay
- Research Centre of the Centre Hospitalier de l'Université de Montréal, 900 Saint Denis Street, Montreal, H2X 0A9, QC, Canada. .,Quebec Public Health Laboratory, Sainte-Marie Rd, Sainte-Anne-de-Bellevue, H9X 3R5, QC, Canada. .,Faculty of Medecine, Université de Montréal, 2900, boulevard Édouard-Montpetit, Montréal, H3T 1J4, QC, Canada.
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