# Longitudinal changes in circulating biomarkers from baseline to week 48 in treatment-Naïve people living with HIV initiating integrase inhibitor-based antiretroviral therapy

## TL;DR

This study examines how different HIV treatments affect immune and metabolic biomarkers over 48 weeks in people starting treatment for the first time.

## Contribution

The study identifies distinct immunomodulatory effects of non-boosted INSTI-based regimens in treatment-naïve HIV patients.

## Key findings

- All INSTI-based regimens achieved viral suppression and increased CD4+ counts, with the greatest increase in the DTG/ABC/3TC group.
- The DTG/ABC/3TC regimen showed significant changes in IL-10, CD163, and ICAM-1 levels over 48 weeks.
- Distinct longitudinal biomarker patterns suggest potential differences in immune modulation among INSTI-based regimens.

## Abstract

Currently, integrase strand-transfer inhibitors (INSTIs) are the cornerstone of antiretroviral therapy (ART), providing potent viral suppression and good tolerability. Emerging evidence suggests that INSTI-based regimens may exert different effects on immune and metabolic pathways, potentially influencing inflammation and comorbidity risk. This study aimed to evaluate the impact of various first-line INSTI-based regimens on a panel of circulating biomarkers in treatment-naïve individuals with HIV.

We included ART-naïve adults (≥18 years) with confirmed HIV-1 infection initiating a non-boosted INSTI according to the treating physicians’ decisions. The regimen included were bictegravir/emtricitabine/tenofovir alafenamide (BIC/TAF/FTC or Group 1 [G1]), dolutegravir/lamivudine (DTG/3TC or Group 2 [G2]), and dolutegravir/abacavir/lamivudine (DTG/ABC/3TC or Group 3 [G3]). Participants receiving DTG/ABC/3TC were enrolled via the Spanish CoRIS cohort, with samples from the HIV BioBank. Blood samples were collected at baseline and after 48 weeks. Biomarkers were grouped into six categories: pro- and anti-inflammatory cytokines, immune activation, endothelial dysfunction, metabolic markers, and tryptophan catabolism. Changes from baseline were analyzed using Kruskal–Wallis and Dunn’s tests; linear mixed-effects models assessed longitudinal trends.

We included 62 participants. All regimens achieved viral suppression and increased CD4 + counts, with the greatest CD4 + gain in G3. At baseline, G3 had higher TNF, CD40, ICAM-1, and lower IL-10 and leptin levels. After 48 weeks, G3 showed a significant increase in IL-10 and greater declines in CD163 and ICAM-1. Mixed models confirmed distinct longitudinal patterns in CD4 + counts, CD163, and IL-10 in G3.

All INSTI-based regimens led to immune restoration, but modest differences in biomarker trajectories suggest distinct immunomodulatory effects. The clinical relevance of these differences remains unclear and warrants further study to assess their role in long-term comorbidity risk.