期刊
AIDS
卷 19, 期 16, 页码 1807-1818出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/01.aids.0000183629.20041.bb
关键词
antiretroviral drugs; dyslipidemia; HIV; insulin resistance; lipodystrophy
资金
- NCRR NIH HHS [RR00052, RR00036, RR00750, M01 RR05096] Funding Source: Medline
- NIAID NIH HHS [IU01AI3844, AI27664, AI25903, AI25897, AI27668, AI27670, AI46386, AI46370, U01 AI025924, AI38858, U01AI25859, AI38855, UO1 AI025915, AI32782, AI27675] Funding Source: Medline
- PHS HHS [U01A127673, A134832-12] Funding Source: Medline
Objective: To determine if particular components of antiretroviral drug regimens are associated with greater insulin resistance, dyslipidemia, and peripheral lipoatrophy. Methods: Metabolic and body composition variables were measured prospectively over 64 weeks in 334 anti retroviral-naive, HIV-infected subjects who were randomized to receive nelfinavir, efavirenz, or both, combined with zidovudine/lamivudine or didanosine/stavudine in a factorial design, multicenter trial. Subjects assigned to efavirenz (n = 110) were compared with those assigned to nelfinavir (n = 99); subjects assigned to zidovudine/lamivudine (n = 154) were compared with those assigned to didanosine/stavudine (n = 180). A subset of 157 subjects had serial dual-energy X-ray absorptiometry (DEXA) scans. Results: Lipid measures increased in all groups. Greater increases in high density lipoprotein (HDL) cholesterol occurred with efavirenz than with nelfinavir. Greater increases in total cholesterol, non-HDL cholesterol and HDL cholesterol occurred with stavudine and didanosine than with zidovudine/lamivudine. There were no differences in insulin resistance in the comparisons. After initial increases in the first 16 weeks, median limb fat decreased. Greater changes in percentage changes in limb fat occurred with didanosine/stavudine (-16.8%) than with zidovudine/lamivudine (+4.0%; P<0.001 for overall change from baseline) and with nelfinavir (-13.1%) compared with efavirenz (+1.8 %; P = 0.003). Conclusions: Over 64 weeks, all regimens were associated with increases in lipids but insulin resistance did not differ between groups. Regimens containing didanosine/ stavudine and regimens containing nelfinavir were associated with greater loss of limb fat. (c) 2005 Lippincott Williams & Wilkins
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