Long-term body composition and metabolic changes in antiretroviral naive persons randomized to protease inhibitor-, nonnucleoside reverse transcriptase inhibitor-, or protease inhibitor plus nonnucleoside reverse transcriptase inhibitor-based strategy.
OBJECTIVE
To assess changes in metabolic parameters and body composition among 422 antiretroviral-naive patients randomized to 3 antiretroviral therapy (ART) strategies: protease inhibitor (PI; n = 141)-, nonnucleoside reverse transcriptase inhibitor (NNRTI; n = 141)-, or PI + NNRTI (n = 140)-based strategies with a median follow-up of 5 years.


METHODS
At baseline and 1-month (metabolic parameters only) and 4-month follow-up intervals, fat-free mass (FFM) and total body fat were calculated, anthropometric measurements were performed, and fasting metabolic parameters were obtained. Rates of change and mean change were compared.


RESULTS
The PI + NNRTI strategy resulted in greater increases in triglycerides and low-density lipoprotein cholesterol compared with the PI and the NNRTI strategies (P < 0.005), with no differences between the PI and NNRTI strategies. High-density lipoprotein cholesterol increased significantly more in the NNRTI strategy than in the PI strategy (P < 0.005). Insulin and insulin resistance increased similarly with all 3 strategies. Changes in total and regional body composition (loss of subcutaneous tissue area and gains in FFM, nonsubcutaneous tissue area, and visceral tissue area) were observed but did not differ by strategy.


CONCLUSIONS
Long-term follow-up of participants initiating 3 ART strategies demonstrated similar changes in total and regional fat, with no differences by ART strategy. The differential effects on lipid metabolism by strategy and the overall increases in insulin and insulin resistance with all 3 strategies necessitate close monitoring of patients on ART.
Shlay
Judith C
JC
Denver Community Programs for Clinical Research on AIDS, Department of Family Medicine, University of Colorado Health Sciences Center, and Denver Public Health, 605 Bannock Street, Denver, CO 80204, USA. jshlay@dhha.org
Bartsch
Glenn
G
Peng
Grace
G
Wang
Jack
J
Grunfeld
Carl
C
Gibert
Cynthia L
CL
Visnegarwala
Fehmida
F
Raghavan
Sai Subhasree
SS
Xiang
Ying
Y
Farrough
Martha
M
Perry
Harold E
HE
Kotler
Donald
D
El-Sadr
Wafaa M
WM
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D001786:Blood Glucose / Q000378:metabolism; D001823:Body Composition / Q000187:drug effects*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D017320:HIV Protease Inhibitors / Q000008:administration & dosage*; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage*; D013997:Time Factors
D019380:Anti-HIV Agents; D001786:Blood Glucose; D017320:HIV Protease Inhibitors; D008055:Lipids; D018894:Reverse Transcriptase Inhibitors