Improvement in insulin sensitivity and serum leptin concentration after the switch from a ritonavir-boosted PI to raltegravir or dolutegravir in non-diabetic HIV-infected patients

Objectives An observational, prospective, cohort study was performed to assess changes in insulin sensitivity and serum leptin level after a switch from a ritonavir-boosted PI (PI/r) to raltegravir or dolutegravir in HIV-infected adults on stable combination ART (cART). Methods Non-diabetic HIV-infected patients receiving suppressive cART including tenofovir disoproxil fumarate/emtricitabine plus one PI/r, who underwent a switch from the PI/r to raltegravir (group A) or dolutegravir (group B), were enrolled in the study. Serum levels of insulin, leptin and the homeostasis model assessment of insulin resistance (HOMA) index were evaluated during a 12month follow-up. Results Overall, 86 patients were enrolled: 45 patients were included in group A and 41 were included in group B. The mean age was 45.7years and 74 (86%) patients were male. After 12months of follow-up, a significant reduction in the mean concentration of leptin and insulin was reported both in group A [-0.61ng/mL (P<0.001) and -2.5 mIU/L (P=0.008), respectively] and in group B [-0.54ng/mL (P=0.005) and -2.1 mIU/L (P=0.017), respectively], without a significant difference between the groups. A significant and comparable reduction in the mean HOMA index was reported both in group A [-0.55 (P=0.004)] and in group B [-0.49 (P<0.001)], as well as a significant decrease in lipid levels. Conclusions In HIV-positive subjects on suppressive cART, the switch from a PI/r to raltegravir or dolutegravir led to a significant and comparable reduction in both HOMA index and serum leptin level, reflecting a similar and significant improvement in insulin sensitivity.