Figen Sarigul#, User U, Oztoprak N


Health Sciences University, Antalya Education and Research Hospital, Infectious Disease and Clinical Microbiology, Antalya, Turkey


Introduction: In HIV infected patients, CD4 + T cell number indicates immunological function, but the CD4/CD8 ratio is an indicator of immune dysfunction, a prognostic marker for non-AIDS mortality, and reflects viral reservoir size in HIV patients. We aimed to investigate comparison of three integrase strand transfer inhibitors (INSTIs) with CD4+ T cell count, CD4/CD8 ratio normalization and virological suppression in HIV-1 infected patients.

Methods: This retrospective comparative case series study was carried out in HIV-1 positive treatment naive patients who initiated antiretroviral regime between 2016 and 2018 with raltegravir (RAL), elvitegravir/cobicistat (EVG) and dolutegravir (DTG). 

Results: Laboratory and clinical characteristics of the patients used RAL (n=28), EVG (n=29) and DTG (n=32). Therapy response rate at 12th month in patients; did not reveal a statistically significant difference between the CD4/CD8 ratio (p=0.4345), did reveal a statistically significant difference at one percent between HIV RNA levels (p=0.0003). However, the increase of CD4+T cell count was higher in DTG than the others (p=0.003). RAL was inferior to the others about virological response at months 3rd, 6th and 12th. On the other hand, there was no statistically significant difference between EVG and DTG in virological response. The safety profile of RAL, EVG and DTG was generally the same.

Conclusions: In HIV infected patients, to control viral replication, which is the main cause of persistent immunological activation and inflammation is important. All three INSTIs had similar activity in CD4/CD8 ratio normalization but DTG increased the number of CD4+ T cell count and gave a high immunological response at 12th months. RAL showed inferior activity in virological suppression at 3, 6 and 12th months. Our real-life outcomes can be a guide for patients in need of immunological healing in late presenters, as well as patients who require rapid virological response.


Raltegravir, Elvitegravir, Dolutegravir, HIV, CD4:CD8 ratio, Integrase inhibitors.