A Closer Look at Integrase Inhibitors, Managing Cognitive Function in Older Adults With HIV

In this Roundtable Wrap-Up, we offer an abbreviated version of the roundtable discussion reviewing new results from the Swiss HIV Cohort Study released at CROI 2023, guarding against cognitive issues in older patients with HIV, and the movement toward long-acting treatments for older adults.

For more expert insights, watch the full Multidisciplinary Roundtable. 

Additional Resource:  

1. Surial B, Chammartin F, Damas J, et al. Impact of integrase inhibitors on cardiovascular events in persons starting ART, Talk presented at: Conference on Retroviruses and Opportunistic Infections (CROI) 2023; February 19-22, 2023; Seattle, WA. Accessed March 10, 2023. https://www.croiconference.org/abstract/impact-of-integrase-inhibitors-on-cardiovascular-events-in-persons-starting-art/

The content below has been edited for space and clarity.

 Milena Murray, PharmD, MS, discussing the Swiss HIV cohort study on the use of integrase inhibitors.¹

I think this helps to tailor our personal algorithms, but I think that we are just at the tip of the iceberg with all of these metabolic issues with many of our regimens, and trying to really figure out what is going to be the best for the person sitting in front of you, is going to be very important.

 Jonathan Applebaum, MD, on the possible impact the study's data¹ has on clinical practice. 

I guess the bottom line is, is this going to change what we're already doing? I think there are so many advantages to using integrase inhibitors that with this data, I'm personally not going to change my practice. It does give me pause to think that maybe there might be other anchor drugs that potentially, may be also a viable option.

But personally, we have come a long way in caring for our patients with HIV, and the integrase class, I guess in my opinion, can't be bested as far as potency and virtual lack of significant side effects.

 David Vance, PhD, MGS, MS, on how aging adults with HIV can protect cognitive function.

I think what we have also shown is that a lot of people don't know how to protect their cognitive functioning as they age. And there's a host of things that people can do.

We do a lot of work in cognitive training, a lot of those computerized cognitive training programs. But one of the best things you can do is physical exercise or reduce alcohol intake or things of that nature. Those are the sort of things that we really want to focus on. It's just general, overall good health will support overall brain health.

 Jonathan Applebaum, MD, on the movement toward long-acting HIV treatments for older adults. 

I think every patient has their individual lifestyle and desires. For some people, a pill once a day is fine, but for others, every day they take that pill reminds them that they're living with HIV. As we talked about earlier there are still a lot of stigmas. There are health disparities, there are socioeconomic issues, and access to care, all of the social determinants. I think that plays a role in what is the best treatment for the patient in front of you. And I think the more options we have, the better. And I think we're going to have even better options down the road.