title: Lipoprotein Changes in HIV-Infected Antiretroviral-Naïve Individuals after Starting Antiretroviral Therapy: ACTG Study A5152s Stein: Lipoprotein Changes on Antiretroviral Therapy.
abstract: BACKGROUND: Dyslipidemia is a frequent complication of antiretroviral therapy (ART) for patients with human immunodeficiency virus infection (HIV). The effects of ART on lipoproteins are less well-understood, and have not been investigated in a prospective study where assignment to ART is randomized.  OBJECTIVE: To evaluate the effects of three class-sparing ART regimens on lipids and lipoproteins.  METHODS: This was a substudy of a prospective, multicenter study treatment-naïve HIV-infected individuals randomly assigned to receive a regimen of nucleoside reverse transcriptase inhibitors (NRTIs) + the non-nucleoside reverse transcriptase inhibitor efavirenz, NRTIs + the protease inhibitor lopinavir/ritonavir, or a NRTI-sparing regimen of efavirenz + lopinavir/ritonavir. Lipoproteins were measured by nuclear magnetic resonance spectroscopy.  RESULTS: Among the 82 participants, total and small low-density lipoprotein concentrations increased (median, interquartile range) by 152 (-49 - +407, p<0.01) and 130 (-98 - +417, p<0.01) nmol/L, respectively, especially in the arms containing lopinavir/ritonavir (p(KW)<0.04). Very low-density lipoproteins also increased (p<0.01), with a larger increase in the arms that contained lopinavir/ritonavir (p=0.022). High-density lipoproteins increased by 6.0 nmol/L (2.8 - 10.4, p<0.01), but differences between arms were not significant (p(KW)=0.069). Changes were not related to changes in markers of insulin/glucose metabolism.  CONCLUSIONS: Total and small low-density lipoprotein concentrations increased, especially in the arms containing lopinavir/ritonavir, as did increases in total very low-density lipoproteins. Adverse changes were especially prominent in the arm with efavirenz + lopinavir/ritonavir.
authors: University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors: James H
authors: JH
authors: Stein
authors: Lauren
authors: L
authors: Komarow
authors: Bruno R
authors: BR
authors: Cotter
authors: Judith S
authors: JS
authors: Currier
authors: Michael P
authors: MP
authors: Dubé
authors: Carl J
authors: CJ
authors: Fichtenbaum
authors: Mariana
authors: M
authors: Gerschenson
authors: Carol K C
authors: CK
authors: Mitchell
authors: Robert L
authors: RL
authors: Murphy
authors: Kathleen
authors: K
authors: Squires
authors: Robert A
authors: RA
authors: Parker
authors: Francesca J
authors: FJ
authors: Torriani