Longitudinal changes in readily available inflammatory markers before and after switching to integrase inhibitor‐based antiretroviral therapy in Virologically suppressed people living with HIV : A Nationwide real‐world cohort study

BACKGROUND: Persistent immune activation and systemic inflammation remain key features of chronic HIV infection despite sustained virological suppression under antiretroviral therapy (ART), contributing to excess non-AIDS morbidity and mortality. Readily available markers from routine laboratory testing, including CD4/CD8 ratio, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), have been associated with systemic inflammation, but their evolution following ART switch remains insufficiently characterized. OBJECTIVES: To characterize longitudinal changes in inflammatory markers before and after switching to integrase strand transfer inhibitor (INSTI)-based therapy in virologically suppressed people living with HIV (PLWH), and to explore differences between bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) and dolutegravir/lamivudine (DTG/3TC). METHODS: We conducted a retrospective longitudinal analysis within the AMACS cohort. Virologically suppressed adults on stable boosted PI- or NNRTI-based regimens who switched to INSTI-based therapy were included. Changes in CD4/CD8 ratio, NLR and PLR were evaluated before and after switch using mixed-effects models, with subgroup analyses by post-switch regimen. RESULTS: Of 2178 potentially eligible participants, a total of 1641 individuals contributed to the primary longitudinal analysis of marker trajectories. PLR values were modestly lower at 6 and 12 months after the switch than at 6 months before the switch in both pre-switch ART groups. However, the differences between pre- and post-switch PLR slopes were not statistically significant. The CD4/CD8 ratio increased progressively over time with no evidence of significant acceleration following the switch, whereas NLR remained largely unchanged. In exploratory subgroup analyses, no consistent differences in inflammatory markers were observed between participants switching to B/F/TAF and those switching to DTG/3TC, while there was a dynamic pattern of NLR in the DTG/3TC subgroup. CONCLUSIONS: In virologically suppressed PLWH, modestly lower PLR values were observed after switching to INSTI-based therapy, whereas CD4/CD8 trajectories were consistent with ongoing immune recovery and NLR remained unchanged.