Open Forum Infectious Diseases, November 2019
A5260s was a sub-study of A5257 in which ART-naïve individuals with HIV were randomized to receive atazanavir (ATV)/ritonavir (r), darunavir/r, or raltegravir. The objectives of A5260s were to compare cardiovascular markers, body composition, and immune activation between those initiating the three different regimens. This analysis in the A5260s study found that, among participants of A5257, beta-D-glucan (BDG, a marker of fungal translocation) increased over two years, irrespective of whether individuals were randomized to either of the two protease inhibitors or the integrase inhibitor. This finding may be as a result of ongoing intestinal damage that occurs despite successful ART. The study also found that BDG was associated with larger fat gains on therapy, supporting prior data from ACTG 5260s showing that a marker of intestinal injury was a strong predictor of fat gains on treatment. This research highlights the potential effect of gut dysfunction on metabolic comorbidities in HIV.