Lipid-lowering effect and efficacy after switching to etravirine in HIV-infected patients with intolerance to suppressive HAART.
OBJECTIVE
Etravirine (ETR) has shown a good lipid profile in previous studies. The aim of this study was to determine the virologic, immunologic, and lipid outcome in HIV-infected patients switching to an ETR-based antiretroviral regimen due to intolerance or toxicity.


METHODS
Observational cohort study of 125 HIV-infected patients who switched therapy to an ETR-based regimen. The lipid profile, including total triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) was compared after 24 weeks.


RESULTS
Patients changed from efavirenz (n = 34; 28%) and ritonavir-boosted protease inhibitors (PI/r; 67 cases: 21 atazanavir, 21 lopinavir, 11 fosamprenavir, 14 darunavir). Hyperlipidemia was the cause in only 22 patients (18%). At 24 weeks, a significant decrease was observed in mean TC level (-8%), LDL-C (-8%), TC:HDL ratio (-6%), and TG level (-20%). For patients receiving previously efavirenz, there was a significant reduction in TC (-23 mg/dL; -13%) and LDL-C (-25 mg/dL; -21%) levels and a trend to a better TG level (-38 mg/dL; -21%;P = .06). In the case of prior PI/r therapy, there was also a significant reduction in TC (-14 mg/dL; -6%) and TG levels (-58 mg/dL; -16%), mostly in prior lopinavir- or fosamprenavir-based therapy (TC -15%; TG -53%). Median CD4+ count increased from 513 to 621 cells/µL (P = .03), and there were only 3 cases of virologic failure (2%).


CONCLUSIONS
In patients switching to an ETR-containing regimen, there is a significant improvement of lipids and maintenance of immunologic and virologic response. This lipid-lowering effect was irrespective of the presence of previous hyperlipidemia and for patients receiving different antiretroviral drugs.
Department of Infectious Diseases, Hospital Ramón y Cajal, Madrid, Spain. jcasado.hrc@salud.madrid.org
José L
JL
Casado
Ignacio
I
de Los Santos
María
M
Del Palacio
Lucio
L
García-Fraile
María J
MJ
Pérez-Elías
Jesús
J
Sanz
Santiago
S
Moreno
D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000069446:Atazanavir Sulfate; D048588:Benzoxazines / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002219:Carbamates / Q000627:therapeutic use; D015331:Cohort Studies; D003521:Cyclopropanes; D000069454:Darunavir; D004359:Drug Therapy, Combination; D005260:Female; D005663:Furans; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism / Q000821:virology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D008055:Lipids / Q000097:blood*; D061466:Lopinavir / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009570:Nitriles; D009842:Oligopeptides / Q000627:therapeutic use; D010755:Organophosphates / Q000627:therapeutic use; D011724:Pyridazines / Q000627:therapeutic use*; D011725:Pyridines / Q000627:therapeutic use; D011743:Pyrimidines; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D019438:Ritonavir / Q000627:therapeutic use; D013030:Spain; D013449:Sulfonamides / Q000627:therapeutic use; D016896:Treatment Outcome
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D002219:Carbamates; D003521:Cyclopropanes; D005663:Furans; D017320:HIV Protease Inhibitors; D008055:Lipids; D009570:Nitriles; D009842:Oligopeptides; D010755:Organophosphates; D011724:Pyridazines; D011725:Pyridines; D011743:Pyrimidines; D018894:Reverse Transcriptase Inhibitors; D013449:Sulfonamides; C451734:etravirine; D061466:Lopinavir; D000069446:Atazanavir Sulfate; C098320:efavirenz; D019438:Ritonavir; C426859:fosamprenavir; D000069454:Darunavir