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Lipid changes in patients initiating efavirenz- and indinavir-based antiretroviral regimens
Karen T Tashima1, Linda Bausserman, Elizabeth N Alt
1Department of Medicine, Brown University School of Medicine, Providence, Rhode Island. ktashima@lifespan.org
Insights
Highly Active Antiretroviral Therapy (HAART) regimens containing efavirenz (EFV) and indinavir (IDV) independently increase total and HDL cholesterol levels. Men on IDV-containing regimens showed a significant rise in total cholesterol, increasing cardiovascular risk.
Area of Science:
- * HIV/AIDS research
- * Pharmacology
- * Cardiovascular health
Background:
- * Highly Active Antiretroviral Therapy (HAART) is crucial for managing HIV infection.
- * Understanding the impact of different HAART regimens on lipid profiles is essential for long-term patient care.
- * Nonfasting lipid levels are increasingly recognized as important clinical indicators.
Purpose of the Study:
- * To evaluate the effects of three specific HAART regimens on nonfasting lipid levels.
- * To compare lipid alterations across efavirenz + zidovudine + lamivudine (EFV+ZDV+3TC), efavirenz + indinavir (EFV+IDV), and indinavir + zidovudine + lamivudine (IDV+ZDV+3TC) regimens.
Main Methods:
- * Analysis of nonfasting lipid levels (total cholesterol and HDL cholesterol) from a large, randomized, multicenter HIV treatment trial.
- * Data collected at prescribed intervals during HAART initiation.
- * Focus on high-density lipoprotein (HDL) and total cholesterol assessments.
Main Results:
- * All three HAART regimens led to an increase in total cholesterol (23-57 mg/dL).
- * Efavirenz (EFV) and indinavir (IDV) independently elevated lipid levels, with additive effects noted in the EFV+IDV arm.
- * HDL cholesterol increased in all arms, most significantly in those containing EFV. Women showed significant HDL increases across all arms, while men only showed increases in EFV-containing arms. Men on IDV-containing regimens experienced a greater rise in total cholesterol, increasing the total/HDL cholesterol ratio.
Conclusions:
- * Both EFV and IDV are associated with independent increases in lipid levels.
- * Elevated lipid levels, particularly the total/HDL cholesterol ratio in men on IDV, may increase cardiovascular risk.
- * Significant differences in HDL cholesterol changes were observed between men and women.
Purpose:
To evaluate nonfasting lipid levels in a large cohort of patients on three HAART regimens: efavirenz + zidovudine + lamivudine (EFV+ZDV+3TC), efavirenz + indinavir (EFV+IDV), and indinavir + zidovudine + lamivudine (IDV+ZDV+3TC).
Method:
Nonfasting lipid levels were analyzed from a large randomized multicenter treatment trial for HIV-infected patients initiating HAART. Treatment evaluations were carried out at prescribed intervals, and data were recorded and analyzed. Assessment was limited to high-density lipoprotein (HDL) and total cholesterol.
Results:
The results demonstrate an increase in the total cholesterol, ranging from 23 to 57 mg/dL, in the three combinations of HAART therapy. The increase was most significant in the EFV+IDV arm where the effects appear to be additive. HDL cholesterol also increased in all three arms, but the greatest increase was in the two groups containing EFV. In all three arms, the HDL cholesterol increased significantly in women while increases in men were seen only in the EFV-containing arms. Men taking either IDV-containing regimen had a greater increase in total cholesterol, and therefore the total/HDL cholesterol ratio rose significantly.
Conclusion:
EFV and IDV independently elevate lipid levels. Alterations in the lipid levels may lead to increased cardiovascular risk in men, possibly mitigated by elevations in HDL cholesterol. In addition, changes in HDL cholesterol were significantly different between men and women.