Clinical Report: Elevated Levels of IL-18 and MIG Observed One Year After Switching to Dolutegravir-Based Dual Therapy Despite Continued Viral Suppression

Overview

This study investigates the dynamics of inflammatory cytokines in people with HIV who switched from a three-drug regimen to a dolutegravir-based two-drug regimen. Notably, increased levels of IL-18 and MIG were observed at 12 months, despite sustained viral suppression.

Background

The transition from three-drug regimens (3DRs) to two-drug regimens (2DRs) in antiretroviral therapy has been associated with comparable efficacy and safety. However, persistent low-grade inflammation in virologically suppressed individuals with HIV raises concerns about non-AIDS comorbidities. Understanding the inflammatory response in this context is crucial for managing long-term health outcomes in people living with HIV.

Data Highlights

Key Findings

• 35 virologically suppressed participants were included in the study.
• At month 12, IL-18 levels increased from 63.33 pg/mL to 75.10 pg/mL (p = 0.009).
• MIG levels rose from 2785 pg/mL to 2966 pg/mL (p = 0.017).
• No significant changes were observed in total lymphocyte CD4+ count or CD4+/CD8+ ratio.
• IL-6 and IP-10 levels remained stable throughout the study period.
• The rise in IL-18 was not correlated with changes in IL-18BP levels.

Clinical Implications

The observed increase in IL-18 and MIG levels suggests that switching to a dolutegravir-based dual therapy may not mitigate proinflammatory responses in people with HIV. Continuous monitoring of inflammatory biomarkers may be necessary to understand their implications for long-term health.

Conclusion

The study highlights the need for further investigation into the inflammatory dynamics following a switch to dual therapy in HIV treatment, particularly regarding the implications for non-AIDS comorbidities.

Related Resources & Content

1. Frontiers, Frontiers in Immunology, 2026 -- IL-18 and MIG Increase One Year After Transition to Dolutegravir-Based Dual Therapy Despite Sustained Viral Suppression
2. the medicine maker — Study Explores Liver Outcomes After HIV Treatment Switch
3. The Journal of Infectious Diseases — Outcomes of Virology and Immunology Following Combined Therapeutic Strategies and Dendritic Cell Therapy in Individuals Living with HIV
4. The Journal of Infectious Diseases — Effects of First-Line Antiretroviral Therapy with Dolutegravir and Lamivudine on HIV-1 Reservoirs and Inflammatory Biomarkers in Peripheral Blood
5. Open Forum Infectious Diseases — Long-Term Outcomes Following the Transition to Dolutegravir Amidst Significant Civil Unrest in Haiti: A Three-Year Analysis
6. WHO releases updated recommendations on HIV clinical management
7. Very-Low-Level Viremia, Inflammatory Biomarkers, and Associated Baseline Variables: Three-Year Results of the Randomized TANGO Study | Open Forum Infectious Diseases | Oxford Academic
8. Frontiers | IL-18 and MIG Increase One Year After Transition to Dolutegravir-Based Dual Therapy Despite Sustained Viral Suppression