Lipid changes in patients initiating efavirenz- and indinavir-based antiretroviral regimens.
OBJECTIVE
To evaluate nonfasting lipid levels in a large cohort of patients on three HAART regimens: efavirenz + zidovudine + lamivudine (EFV+ZDV+3TC), efavirenz + indinavir (EFV+IDV), and indinavir + zidovudine + lamivudine (IDV+ZDV+3TC).


METHODS
Nonfasting lipid levels were analyzed from a large randomized multicenter treatment trial for HIV-infected patients initiating HAART. Treatment evaluations were carried out at prescribed intervals, and data were recorded and analyzed. Assessment was limited to high-density lipoprotein (HDL) and total cholesterol.


RESULTS
The results demonstrate an increase in the total cholesterol, ranging from 23 to 57 mg/dL, in the three combinations of HAART therapy. The increase was most significant in the EFV+IDV arm where the effects appear to be additive. HDL cholesterol also increased in all three arms, but the greatest increase was in the two groups containing EFV. In all three arms, the HDL cholesterol increased significantly in women while increases in men were seen only in the EFV-containing arms. Men taking either IDV-containing regimen had a greater increase in total cholesterol, and therefore the total/HDL cholesterol ratio rose significantly.


CONCLUSIONS
EFV and IDV independently elevate lipid levels. Alterations in the lipid levels may lead to increased cardiovascular risk in men, possibly mitigated by elevations in HDL cholesterol. In addition, changes in HDL cholesterol were significantly different between men and women.
Tashima
Karen T
KT
Department of Medicine, Brown University School of Medicine, Providence, Rhode Island. ktashima@lifespan.org
Bausserman
Linda
L
Alt
Elizabeth N
EN
Aznar
Esther
E
Flanigan
Timothy P
TP
D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D048588:Benzoxazines; D018791:CD4 Lymphocyte Count; D002784:Cholesterol / Q000097:blood*; D008076:Cholesterol, HDL / Q000097:blood*; D003521:Cyclopropanes; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D019469:Indinavir / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D010078:Oxazines / Q000009:adverse effects* / Q000627:therapeutic use; D012367:RNA, Viral / Q000032:analysis; D012727:Sex Characteristics; D013997:Time Factors
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D008076:Cholesterol, HDL; D003521:Cyclopropanes; D010078:Oxazines; D012367:RNA, Viral; D019469:Indinavir; D002784:Cholesterol; C098320:efavirenz