title: HIV lipodystrophy in participants randomised to lopinavir/ritonavir (LPV/r) +2-3 nucleoside/nucleotide reverse transcriptase inhibitors (N(t)RTI) or LPV/r + raltegravir as second-line antiretroviral therapy.
abstract: OBJECTIVE
  To compare changes over 48 weeks in body fat, lipids, Metabolic Syndrome and cardiovascular disease risk between patients randomised 1:1 to lopinavir/ritonavir (r/LPV) plus raltegravir (RAL) compared to r/LPV plus 2-3 nucleoside/nucleotide reverse transcriptase inhibitors (N(t)RTIs) as second-line therapy.
  
  
  METHODS
  Participants were HIV-1 positive (>16 years) failing first-line treatment (2 consecutive HIV RNA >500 copies/mL) of NNRTI +2N(t)RTI. Whole body dual energy x-ray absorptiometry was performed at baseline and week 48. Data were obtained to calculate the Metabolic Syndrome and Framingham cardiovascular disease (CVD) risk score. Linear regression was used to compare mean differences between arms. Logistic regression compared incidence of metabolic syndrome. Associations between percent limb fat changes at 48 weeks with baseline variables were assessed by backward stepwise multivariate linear regression. Analyses were adjusted for gender, body mass index and smoking status.
  
  
  RESULTS
  210 participants were randomised. The mean (95% CI) increase in limb fat over 48 weeks was 15.7% (5.3, 25.9) or 0.9 kg (0.2, 1.5) in the r/LPV+N(t)RTI arm and 21.1% (11.1, 31,1) or 1.3 kg (0.7, 1.9) in the r/LPV+RAL arm, with no significant difference between treatment arms (-5.4% [-0.4 kg], p>0.1). Increases in total body fat mass (kg) and trunk fat mass (kg) were also similar between groups. Total:HDL cholesterol ratio was significantly higher in the RAL arm (mean difference -0.4 (1.4); p = 0.03), there were no other differences in lipid parameters between treatment arms. There were no statistically significant differences in CVD risk or incidence of Metabolic Syndrome between the two treatment arms. The baseline predictors of increased limb fat were high viral load, high insulin and participant's not taking lipid lowering treatment.
  
  
  CONCLUSIONS
  In patients switching to second line therapy, r/LPV combined with RAL demonstrated similar improvements in limb fat as an N(t)RTI + r/LPV regimen, but a worse total:HDL cholesterol ratio over 48 weeks.
  
  
  BACKGROUND
  This clinical trial is registered on Clinicaltrials.gov, registry number NCT00931463 http://clinicaltrials.gov/ ct2/show/NCT00931463?term = NCT00931463&rank = 1.
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Allison
authors.initials: A
authors.lastname: Martin
authors.forename: Cecilia L
authors.initials: CL
authors.lastname: Moore
authors.forename: Patrick W G
authors.initials: PW
authors.lastname: Mallon
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Hoy
authors.forename: Sean
authors.initials: S
authors.lastname: Emery
authors.forename: Waldo H
authors.initials: WH
authors.lastname: Belloso
authors.forename: Praphan
authors.initials: P
authors.lastname: Phanuphak
authors.forename: Samuel
authors.initials: S
authors.lastname: Ferret
authors.forename: David A
authors.initials: DA
authors.lastname: Cooper
authors.forename: Mark A
authors.initials: MA
authors.lastname: Boyd
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D050218:Body Fat Distribution; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism / Q000473:pathology; D002784:Cholesterol / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D015497:HIV-1 / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008060:Lipodystrophy / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D016015:Logistic Models; D061466:Lopinavir / Q000627:therapeutic use*; D008297:Male; D024821:Metabolic Syndrome / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism / Q000473:pathology; D008875:Middle Aged; D011760:Pyrrolidinones / Q000627:therapeutic use*; D012367:RNA, Viral / Q000037:antagonists & inhibitors / Q000096:biosynthesis; D000068898:Raltegravir Potassium; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D012307:Risk Factors; D019438:Ritonavir / Q000627:therapeutic use*; D019562:Viral Load / Q000187:drug effects; D014779:Virus Replication / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents; D011760:Pyrrolidinones; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors; D061466:Lopinavir; D000068898:Raltegravir Potassium; D002784:Cholesterol; D019438:Ritonavir