title: Lipid profiles for antiretroviral-naive patients starting PI- and NNRTI-based therapy in the Swiss HIV cohort study.
abstract: BACKGROUND
  Blood lipid abnormalities in patients on highly active antiretroviral therapy (HAART) have been associated with exposure to protease inhibitors (PIs), particularly ritonavir. First therapy with a non-nucleoside reverse transcriptase inhibitor (NNRTI) leads to relatively favourable lipid profiles. We report on medium-term lipid profiles (up to 5 years) for antiretroviral-naive patients starting NNRTI- and PI-based HAART in the Swiss HIV Cohort Study.
  
  
  METHODS
  Since April 2000, blood samples taken at visits scheduled every 6 months have been analysed for cholesterol and triglyceride concentrations. For 1065 antiretroviral-naive patients starting HAART after April 2000, we estimated changes in concentration over time using multivariate linear regression with adjustment for baseline covariates, use of lipid-lowering drugs and whether the sample was taken in a fasting state.
  
  
  RESULTS
  Non-high density lipoprotein (HDL) cholesterol levels increase with increasing exposure to either PI- or NNRTI-based therapy, HDL cholesterol levels increase and triglyceride levels decrease with increasing exposure to NNRTI-based therapy, whereas triglyceride levels increase with increasing exposure to PI-based therapy. Between NNRTI-based therapies, there is a slight difference in triglyceride levels, which tend to increase with increasing exposure to efavirenz and to decrease with increasing exposure to nevirapine. Of the three common PI-based therapies, nelfinavir appears to have a relatively favourable lipid profile, with little change with increasing exposure. Of the other two PI therapies, lopinavir with ritonavir has a more favourable profile than indinavir with ritonavir, with smaller increases in both non-HDL cholesterol and triglycerides and an increase in HDL cholesterol. Increasing exposure to abacavir is associated with a decrease in the level of triglycerides.
  
  
  CONCLUSIONS
  In general, NNRTI-based therapy is associated with a more favourable lipid profile than PI-based therapy, but different PI-based therapies are associated with very different lipid profiles. Nelfinavir appears to have a relatively favourable lipid profile. Of the two boosted PI therapies, lopinavir appears to have a more favourable lipid profile than indinavir.
authors.affiliation: Institut für klinisehe Epidemiologie, Universitätsspital Basel, Basel, Switzerland. jyoung@uhbs.ch
authors.forename: Jim
authors.initials: J
authors.lastname: Young
authors.forename: Rainer
authors.initials: R
authors.lastname: Weber
authors.forename: Martin
authors.initials: M
authors.lastname: Rickenbach
authors.forename: Hansjakob
authors.initials: H
authors.lastname: Furrer
authors.forename: Enos
authors.initials: E
authors.lastname: Bernasconi
authors.forename: Bernard
authors.initials: B
authors.lastname: Hirschel
authors.forename: Philip E
authors.initials: PE
authors.lastname: Tarr
authors.forename: Pietro
authors.initials: P
authors.lastname: Vernazza
authors.forename: Manuel
authors.initials: M
authors.lastname: Battegay
authors.forename: Heiner C
authors.initials: HC
authors.lastname: Bucher
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000209:etiology; D008055:Lipids / Q000097:blood*; D008297:Male; D011446:Prospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D019438:Ritonavir / Q000494:pharmacology*; D013557:Switzerland; D014280:Triglycerides / Q000097:blood
chemical_list: D017320:HIV Protease Inhibitors; D008055:Lipids; D018894:Reverse Transcriptase Inhibitors; D014280:Triglycerides; D019438:Ritonavir