Effects of first-line use of nucleoside analogues, efavirenz, and ritonavir-boosted protease inhibitors on lipid levels.
BACKGROUND
Treatment with ritonavir-boosted protease inhibitors or efavirenz and nucleoside analogues leads to rises in lipids, which might contribute to cardiovascular risk.


METHODS
A MEDLINE search for clinical trials of first-line HAART with standardized 48-week lipids data available for combinations of two nucleoside analogues identified 13 with additional boosted protease inhibitor (PI/r) regimens (n = 5,281) and two with efavirenz (n = 1,087). Inverse-variance weighting was used to provide estimates of combined 48-week elevations in each lipid parameter.


RESULTS
The trials were well balanced for mean baseline total cholesterol (155 mg/dL), triglycerides (125 mg/dL), LDL (95 mg/dL), and HDL (37 mg/dL). The PIs showed two different types of lipid elevations: Group 1: saquinavir/r, atazanavir/r, and darunavir/r; and Group 2: lopinavir/ritonavir and fosamprenavir/r. There were greater elevations in total cholesterol and triglycerides for Group 2 compared to Group 1 but no differences in LDL or HDL between Group 1 and Group 2. Patients treated with efavirenz showed similar rises in total cholesterol and LDL compared with the PIs in Group 2 but showed smaller rises than in Group 1. In addition, patients treated with abacavir/lamivudine, zidovudine/lamiuvudine, or stavudine/lamivudine showed significantly higher elevations in all four lipid parameters, compared with patients given tenofovir/emtricitabine.


CONCLUSIONS
There is a wide range of lipid elevations during 48 weeks of first-line HAART, which depends on the choice of antiretrovirals used.
Pharmacology Research Laboratories, University of Liverpool, Liverpool, UK. microhaart@aol.com
Andrew
A
Hill
Will
W
Sawyer
Brian
B
Gazzard
D000480:Alkynes; D023241:Antiretroviral Therapy, Highly Active; D048588:Benzoxazines / Q000627:therapeutic use*; D002784:Cholesterol / Q000097:blood*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D002986:Clinical Trials as Topic; D003521:Cyclopropanes; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000097:blood* / Q000627:therapeutic use*; D006801:Humans; D009705:Nucleosides / Q000627:therapeutic use*; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D019438:Ritonavir / Q000627:therapeutic use*; D014280:Triglycerides / Q000097:blood
D000480:Alkynes; D048588:Benzoxazines; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D003521:Cyclopropanes; D017320:HIV Protease Inhibitors; D009705:Nucleosides; D018894:Reverse Transcriptase Inhibitors; D014280:Triglycerides; D002784:Cholesterol; C098320:efavirenz; D019438:Ritonavir