title: Switch to etravirine for HIV-positive patients receiving statin treatment: a prospective study.
abstract: BACKGROUND
  Lifestyle changes and statins are the cornerstones in management of dyslipidaemia in patients with HIV infection. Replacement of an antiretroviral therapy (ART) component is a proposed therapeutic strategy to reduce cardiovascular risk. In dyslipidaemic patients with HIV infection, we assessed the efficacy of replacing boosted protease inhibitor (bPI) or efavirenz (EFV) by etravirine (ETR) as an alternative to statin therapy.
  
  
  METHODS
  A prospective, open-label, multicentre, 12-week study of patients with HIV infection on ART including bPI or EFV, and statin treatment. Four weeks after statin interruption, bPI or EFV was switched to ETR (400 mg, 8 weeks) if serum low-density lipoprotein cholesterol (LDL-C) was ≥ 3 mM. The primary endpoint was the proportion of patients on ETR with no indication for statin treatment at study completion. Serum levels of HIV RNA, lipids and biomarkers of cardiovascular disease were also measured. (ClinicalTrials.gov: NCT01543035).
  
  
  RESULTS
  The 31 included patients had a HIV-1 RNA < 50 copies/mL (median age, 52 years; median CD4, 709 cell/mL; median LDL-C, 2·89 mM), 68% were on EFV, and 32% were on bPI. At week 4, 27 patients switched to ETR. At study completion, 15 patients (56%) on ETR did not qualify for statin treatment. After the ETR switch, serum levels of the cardiovascular biomarkers sICAM and MCP1/CCL2 decreased by 11·2% and 18·9%, respectively, and those of CCL5/RANTES and tissue inhibitor of metalloproteinase-1 increased by 14·3% and 13·4%, respectively, indicating reduced cardiovascular risk. There were no notable treatment-related adverse events.
  
  
  CONCLUSIONS
  Replacing bPI or EFV by ETR is a viable strategy to obviate primary prevention statin treatment.
authors.affiliation: HIV Unit, Department of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Laura
authors.initials: L
authors.lastname: Ciaffi
authors.affiliation: Department of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Cavassini
authors.affiliation: Department of Infectious Diseases, La Chaux de Fonds Hospital, La Chaux de Fonds, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Genne
authors.affiliation: HIV Unit, Department of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Cecile
authors.initials: C
authors.lastname: Delhumeau
authors.affiliation: HIV Unit, Department of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Rachel
authors.initials: R
authors.lastname: Spycher Elbes
authors.affiliation: Pharmacology Research Laboratories, Liverpool University, Liverpool, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hill
authors.affiliation: Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland.
authors.forename: Gilles
authors.initials: G
authors.lastname: Wandeler
authors.affiliation: Division of Infectious Diseases & Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Fehr
authors.affiliation: Department of Infectious Diseases, Basel Hospital, Basel, Switzerland.
authors.forename: Marcel
authors.initials: M
authors.lastname: Stoeckle
authors.affiliation: Department of Infectious Diseases, St Gallen Hospital, St Gallen, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Schmid
authors.affiliation: HIV Unit, Department of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Bernard
authors.initials: B
authors.lastname: Hirschel
authors.affiliation: Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospital, Geneva, Switzerland.|First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa School of Medicine, Genoa, Italy.|IRCCS Azienda Ospedaliera Universitaria San Martino - IST Instituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Montecucco
authors.affiliation: HIV Unit, Department of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Calmy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000480:Alkynes; D048588:Benzoxazines / Q000627:therapeutic use; D015415:Biomarkers / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003521:Cyclopropanes; D057915:Drug Substitution; D050171:Dyslipidemias / Q000188:drug therapy*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D050356:Lipid Metabolism / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009570:Nitriles; D011446:Prospective Studies; D011724:Pyridazines / Q000627:therapeutic use; D011743:Pyrimidines; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000480:Alkynes; D048588:Benzoxazines; D015415:Biomarkers; D003521:Cyclopropanes; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D009570:Nitriles; D011724:Pyridazines; D011743:Pyrimidines; D018894:Reverse Transcriptase Inhibitors; C451734:etravirine; C098320:efavirenz
keywords: Cardiovascular disease biomarkers; HIV; dyslipidaemia; etravirine; statins