title: Lopinavir plasma concentrations and changes in lipid levels during salvage therapy with lopinavir/ritonavir-containing regimens.
abstract: OBJECTIVE
  To determine whether an association existed between lopinavir (LPV) plasma concentrations and changes in lipid levels.
  
  
  METHODS
  A prospective, nonrandomized study.
  
  
  METHODS
  HIV-infected subjects with virologic failure on protease inhibitor-containing regimens. Twenty-two consecutive patients were enrolled, 19 completed 24 weeks of treatment, and 16 completed the full 48-week study period. INTERVENTION Patients were treated with LPV/ritonavir (LPV/r) in combination with other antiretroviral agents. Subjects were evaluated at baseline and weeks 4, 8, 12, 24, 36, and 48. LPV trough plasma concentrations and lipid levels were measured.
  
  
  RESULTS
  LPV trough concentrations were higher in patients experiencing grade 3 or higher lipid elevations (mean [SD]: 9.71 microg/mL (5.62) vs. 6.09 microg/mL (3.83); P = 0.002) and in those developing grade 2 or higher hypercholesterolemia (mean [SD]: 8.48 microg/mL [4.64] vs. 5.71 microg/mL [3.94]; P = 0.003). All patients developing grade 2 or higher cholesterol elevation had an LPV trough concentration at week 4 greater than 8 microg/mL. Significant positive correlations were found between LPV trough concentrations and changes in triglyceride and cholesterol levels.
  
  
  CONCLUSIONS
  In patients receiving salvage therapy with LPV/r, there is an association between LPV plasma concentrations and lipid changes. Patients achieving higher LPV trough concentrations may be at greater risk of experiencing dyslipidemia. Further investigations are warranted to support a direct cause and effect relationship.
authors.affiliation: Infectious Diseases Unit, Internal Medicine Department, Hospital General Universitario de Elche, Alicante, Spain. gutierrez_fel@gva.es
authors.forename: Félix
authors.initials: F
authors.lastname: Gutiérrez
authors.forename: Sergio
authors.initials: S
authors.lastname: Padilla
authors.forename: Andrés
authors.initials: A
authors.lastname: Navarro
authors.forename: Mar
authors.initials: M
authors.lastname: Masiá
authors.forename: Ildefonso
authors.initials: I
authors.lastname: Hernández
authors.forename: José
authors.initials: J
authors.lastname: Ramos
authors.forename: Angel
authors.initials: A
authors.lastname: Esteban
authors.forename: Alberto
authors.initials: A
authors.lastname: Martin-Hidalgo
mesh_terms: D000328:Adult; D002784:Cholesterol / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006949:Hyperlipidemias / Q000139:chemically induced*; D050356:Lipid Metabolism; D008055:Lipids / Q000097:blood; D061466:Lopinavir; D008297:Male; D011446:Prospective Studies; D011744:Pyrimidinones / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use*; D019438:Ritonavir / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D013997:Time Factors; D014280:Triglycerides / Q000097:blood
chemical_list: D017320:HIV Protease Inhibitors; D008055:Lipids; D011744:Pyrimidinones; D014280:Triglycerides; D061466:Lopinavir; D002784:Cholesterol; D019438:Ritonavir