Switching From HIV Protease Inhibitors to Integrase Strand Transfer Inhibitors Tied to Diabetes Risk

TUESDAY, April 7, 2026 (HealthDay News) -- Switching to integrase strand transfer inhibitors (INSTI) from protease inhibitors is associated with new diabetes risk in people with HIV, according to a study published online March 27 in The Lancet HIV.Y. Joseph Hwang, M.D., from Johns Hopkins University School of Medicine in Baltimore, and colleagues examined the effect of switching to INSTIs on incident diabetes in antiretroviral therapy-experienced people with HIV. The analysis included individual-level data from 27 longitudinal cohorts of adults with HIV in the United States and Canada without diabetes who had used non-nucleoside reverse transcriptase inhibitors (NNRTIs) or protease inhibitors for at least 180 days (in 2016 to 2022) but had never used an INSTI.The researchers identified 13,071 participants with 2,702 encounters in which they switched to an INSTI from an NNRTI, 54,766 in which they continued an NNRTI, 1,714 in which they switched to an INSTI from a protease inhibitor, and 26,599 in which they continued a protease inhibitor. Incident diabetes risk increased with switching from protease inhibitors to INSTIs (adjusted hazard ratio [aHR], 1.38; 95 percent confidence interval [CI], 1.06 to 1.80), in contrast to a nonsignificant increase in incident diabetes risk when switching from NNRTIs to INSTIs (aHR, 1.10; 95 percent CI, 0.87 to 1.39). During the first two years after switching from protease inhibitors to INSTIs, diabetes risk was higher (HR, 1.67; 95 percent CI, 1.21 to 2.30), but not thereafter. Weight gain did not explain the effect of switching from protease inhibitors to INSTIs on diabetes. When examining participants with weight gain of 5 percent or less in the first year after, the switch from protease inhibitors to INSTIs had an HR of 1.37 (95 percent CI, 1.02 to 1.84), and the switch from NNRTIs to INSTIs had an HR of 1.03 (95 percent CI, 0.79 to 1.36)."These findings help people with HIV make informed decisions when switching medications," Hwang said in a statement. "Our analysis is not intended to discourage switching medications, but rather to inform patients and their treating clinicians of the potential metabolic risks that should be weighed in making individualized treatment decisions in such common clinical scenarios."Abstract/Full Text (subscription or payment may be required).Sign up for our weekly HealthDay newsletter

Switching From HIV Protease Inhibitors to Integrase Strand Transfer Inhibitors Tied to Diabetes Risk

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