title: Atherogenic properties of lipoproteins in HIV patients starting atazanavir/ritonavir or darunavir/ritonavir: a substudy of the ATADAR randomized study.
abstract: OBJECTIVE
  To assess LDL subfraction phenotype and lipoprotein-associated phospholipase A2 (Lp-PLA2) in naive HIV-infected patients starting atazanavir/ritonavir or darunavir/ritonavir plus tenofovir/emtricitabine.
  
  
  METHODS
  This was a substudy of a multicentre randomized study. Standard lipid parameters, LDL subfraction phenotype (by gradient gel electrophoresis) and Lp-PLA2 activity (by 2-thio-PAF) were measured at baseline and weeks 24 and 48. Multivariate regression analysis was performed. Results are expressed as the median (IQR).
  
  
  RESULTS
  Eighty-six (atazanavir/ritonavir, n=45; darunavir/ritonavir, n=41) patients were included: age 36 (31-41) years; 89% men; CD4 319 (183-425) cells/mm(3); and Framingham score 1% (0%-2%). No differences in demographics or lipid measurements were found at baseline. At week 48, a mild but significant increase in total cholesterol and HDL-cholesterol was observed in both arms, whereas LDL cholesterol increased only in the darunavir/ritonavir arm and triglycerides only in the atazanavir/ritonavir arm. The apolipoprotein A-I/apolipoprotein B ratio increased only in the atazanavir/ritonavir arm. At week 48, the LDL subfraction phenotype improved in the darunavir/ritonavir arm (increase in LDL particle size and in large LDL particles), whereas it worsened in the atazanavir/ritonavir arm (increase in small and dense LDL particles, shift to a greater prevalence of phenotype B); the worsening was related to the greater increase in triglycerides in the atazanavir/ritonavir arm. No changes in total Lp-PLA2 activity or relative distribution in LDL or HDL particles were found at week 48 in either arm.
  
  
  CONCLUSIONS
  In contrast with what occurred in the atazanavir/ritonavir arm, the LDL subfraction phenotype improved with darunavir/ritonavir at week 48. This difference was associated with a lower impact on plasma triglycerides with darunavir/ritonavir.
authors.affiliation: HIV Unit, Infectious Disease Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Barcelona, Spain msaumoy@bellvitgehospital.cat.
authors.forename: Maria
authors.initials: M
authors.lastname: Saumoy
authors.affiliation: Biomedical Research Institute IIB Sant Pau, Barcelona, Spain Biochemistry and Molecular Biology Department, Universitat Autònoma, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Ordóñez-Llanos
authors.affiliation: Infectious Disease Service, Hospital Clínic, Barcelona, Spain.
authors.forename: Esteban
authors.initials: E
authors.lastname: Martínez
authors.affiliation: HIV Unit, Infectious Disease Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Ferrer
authors.affiliation: Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Domingo
authors.affiliation: Infectious Disease Service, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Esteban
authors.initials: E
authors.lastname: Ribera
authors.affiliation: Fundació Lluita contra la Sida, Hospital Germans Trias i Pujol, Badalona, Spain.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Negredo
authors.affiliation: HIV Unit, Infectious Disease Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Curto
authors.affiliation: Biomedical Research Institute IIB Sant Pau, Barcelona, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Sánchez-Quesada
authors.affiliation: HIV Unit, Infectious Disease Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Silvana
authors.initials: S
authors.lastname: Di Yacovo
authors.affiliation: Infectious Disease Service, Hospital Clínic, Barcelona, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: González-Cordón
authors.affiliation: HIV Unit, Infectious Disease Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Podzamczer
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects / Q000379:methods*; D050197:Atherosclerosis; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008074:Lipoproteins / Q000097:blood*; D008297:Male; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
chemical_list: D044966:Anti-Retroviral Agents; D008074:Lipoproteins; D014280:Triglycerides
keywords: LDL size; LDL subfraction phenotype; lipoprotein-associated phospholipase A2