Metabolic benefits 24 months after replacing a protease inhibitor with abacavir, efavirenz or nevirapine.
OBJECTIVE
To evaluate the 24-month metabolic and morphological benefits obtained from replacing the protease inhibitor (PI) in a regimen with nevirapine, efavirenz or abacavir.


METHODS
NEFA was a randomized study designed to compare the efficacy of nevirapine, efavirenz or abacavir as substitutes for PI. A subset of 90 patients [abacavir (n = 29), efavirenz (n = 32), nevirapine (n = 29)] formed the metabolic study. Fasting total cholesterol (TC), high density lipoprotein cholesterol (HDL-c) and triglycerides levels were determined. Glucose homeostasis parameters were also collected. Lipodystrophy was evaluated by clinical examination and morphological measurements.


RESULTS
Treatment simplification led to overall lipid profile improvements. At 24 months, the two non-nucleoside reverse transcriptase inhibitors produced similar lipid benefits: HDL-c levels increased [efavirenz, 15% (P = 0.001); nevirapine, 21% (P < 0.001)] and TC to HDL-c ratios decreased [efavirenz, 14% (P < 0.001); nevirapine, 19% (P < 0.01)], an effect not observed in the abacavir arm. Non-HDL-c levels decreased by 10% in both the abacavir (P = 0.001) and efavirenz (P < 0.05) arms. Significant decreases in the levels of triglycerides occurred for the first year in all treatments; however, at 24 months most of the initial loss had been regained. Patients with baseline moderate or severe lipodystrophy obtained less-pronounced lipid benefits. Several insulin resistance markers showed a trend towards improvement. Conversely, no improvements in morphological abnormalities were observed.


CONCLUSIONS
Replacing PI with efavirenz, nevirapine or abacavir improved the lipid profile, with more marked results in non-lipodystrophic patients. In contrast, this strategy does not seem to be effective for reversing body fat abnormalities.
Fisac
Cesar
C
Nutrition Section, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. cfisac@csub.scs.es
Fumero
Emilio
E
Crespo
Manuel
M
Roson
Beatriz
B
Ferrer
Elena
E
Virgili
Nuria
N
Ribera
Esteban
E
Gatell
Jose Maria
JM
Podzamczer
Daniel
D
D000328:Adult; D000480:Alkynes; D000886:Anthropometry; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000494:pharmacology*; D023241:Antiretroviral Therapy, Highly Active; D048588:Benzoxazines; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood / Q000187:drug effects; D003521:Cyclopropanes; D015224:Dideoxynucleosides / Q000009:adverse effects / Q000494:pharmacology; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects / Q000494:pharmacology; D015497:HIV-1; D006801:Humans; D007333:Insulin Resistance; D008060:Lipodystrophy / Q000097:blood / Q000209:etiology; D008297:Male; D008875:Middle Aged; D019829:Nevirapine / Q000009:adverse effects / Q000494:pharmacology; D010078:Oxazines / Q000009:adverse effects / Q000494:pharmacology; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects / Q000494:pharmacology*; D014280:Triglycerides / Q000097:blood; D000099227:Abacavir
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D001786:Blood Glucose; D002784:Cholesterol; D008076:Cholesterol, HDL; D003521:Cyclopropanes; D015224:Dideoxynucleosides; D017320:HIV Protease Inhibitors; D019829:Nevirapine; D010078:Oxazines; D018894:Reverse Transcriptase Inhibitors; D014280:Triglycerides; D000099227:Abacavir; C098320:efavirenz