Journal
JOURNAL OF CLINICAL LIPIDOLOGY
Volume 2, Issue 6, Pages 464-471Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacl.2008.08.442
Keywords
Antiretroviral therapy; Cardiovascular risk; Clinical trial; Human immunodeficiency virus; Lipids; Lipoproteins
Categories
Funding
- National Institute of Allergy and Infectious Diseases
- National Heart, Lung, and Blood Institute
- Abbott Laboratories
- Bristol-Myers Squibb Company
- National Institutes of Health (NIH) [AI069424, AI56933, AI069428, AI25859, HL72711, RR00750, RR000750, AI069513, AI34853, RR16467, MD000173, AI069471, AI38855, AI068634, RR16176, AI25915, AI69432, AI38558, AI068636]
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BACKGROUND: Dyslipidemia is a frequent complication of antiretroviral therapy (ART) for patients with human immunodeficiency virus infection (HIV). The effects of ART on lipoproteins are less well-understood, and have not been investigated in a prospective study where assignment to ART is randomized. OBJECTIVE: To evaluate the effects of three class-sparing ART regimens on lipids and lipoproteins. METHODS: This was a substudy of a prospective, multicenter study of treatment-naive HIV-infected individuals randomly assigned to receive a regimen of nucleoside reverse transcriptase inhibitors (NRTIs) + the non-nucleoside reverse transcriptase inhibitor efavirenz, NRTIs + the protease inhibitor lopinavir/ritonavir, or a NRTI-sparing regimen of efavirenz + lopinavir/ritonavir. Lipoproteins were measured by nuclear magnetic resonance spectroscopy. RESULTS: Among the 82 participants, total and small low-density lipoprotein concentrations increased by a median of 152 nmol/L (interquartile range, -49 to +407 nmol/L; P < 0.01) and 130 nmol/L (interquartile range, -98 to +417 nmol/L; P < 0.01), respectively, especially in the arms containing lopinavir/ritonavir (P-KW < 0.04). Very-low-density lipoproteins also increased (P < 0.01), with a larger increase in the arms that contained lopinavir/ritonavir (P = 0.022). High-density lipoproteins increased by a median of 6.0 nmol/L (interquartile range, 2.8-10.4 nmol/L; P < 0.01), but differences between anus were not significant (P-KW = 0.069). Changes were not related to changes in markers of insulin/glucose metabolism. CONCLUSIONS: Total and small low-density lipoprotein concentrations increased, especially in the arms containing lopinavir/ritonavir, as did increases in total very-low-density lipoproteins. Adverse changes were especially prominent in the arm with efavirenz + lopinavir/ritonavir. (C) 2008 National Lipid Association. Published by Elsevier Inc. All rights reserved.
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