van Leth F, Friis-Moller N, Weber R, d'Arminio A, Kirk O, Thiebaut R, Morfeldt L, Pradier C, Calvo G, Law M, Bartsch G, De Wit S, Sabin C, Lundgren JD, Reiss P; Conference on Retroviruses and Opportunistic Infections; The DAD Study Group.

9th Conf Retrovir Oppor Infect Feb 24 28 2002 Wash State Conv Trade Cent Seattle Wash Conf Retrovir Oppor Infect 9th 2002 Seattle Wash. 2002 Feb 24-28; 9: abstract no. 34.

ATHENA, Amsterdam, The Netherlands

BACKGROUND: PI-containing ART is associated with increased plasma total cholesterol (TC) and triglycerides (TG), without much change in HDL-cholesterol (HDL-c). In contrast, a rise in HDL-c leading to a reduced TC/HDL-c ratio has been shown in NNRTI-containing ART. We analysed lipid profiles in patients on different ART at enrolment in the 'Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study, an international study of 20,000+ HIV-infected patients.METHODS: Data were analysed from all participants and a subgroup who entered ART-naive or on first-line PI-, NVP-, or efavirenz (EFV)-containing regimens. Median values of TC,TG, HDL-c, and TC/HDL-c were estimated in a cross-sectional analysis, and risk of dyslipidemia (TC > 6.2 mmol/L, and/or TG > 2.3 mmol/L, and/or HDL-c < 0.9 mmol/L) assessed in a multivariate model.RESULTS: Of 17852 patients enrolled, 11% were ART-naive, 10% not currently on ART, 12% on NRTI, 42% on NRTI + PI, 19% on NRTI + NNRTI, and 7% on PI + NRTI + NNRTI. The proportion of patients with elevated TC in each category was (%): 8, 10, 12, 27, 23, and 45; with elevated TG: 15, 25, 25, 40, 32, and 54; with lowered HDL-c: 23, 35, 25, 27, 19, and 24, respectively. 5007 (28.0 %) were on first-line NRTI+PI and 971 (5.4 %) on first-line NRTI + NNRTI (639 (3.6%) NVP, 329 (1.8%) EFV). Median concentrations in mmol/L for TC, TG, and HDL-c were: 5.4, 1.9, and 1.1 for NRTI +PI; 5.1 ,1.4, and 1.3 for NRTI +NNRTI; 5.1, 1.3, and 1.3 for NVP; 5.1, 1.4, and 1.4 for EFV. The TC/HDL-c ratio for ART-naive, PI, NNRTI, NVP, and EFV was 3.9, 4.9, 3.8, 3.7, and 3.8, respectively. Adjusted OR (95% CI) for elevated TC, TG, and decreased HDL when compared to ART-naives, was 2.10 (1.65-2.67), 2.20 (1.80-2.68), and 1.49 ( 1.15-1.92) for PI; 1.33 (0.99-1.78), 1.23 (0.96-1.58), and 0.71 ( 0.49-1.04) for NNRTI. The OR (95% CI) for increased HDL-c when comparing NNRTI with PI was 2.09 (1.51-2.88), 2.34 (1.50-3.65), and 1.77(1.13-2.75) for NNRTI, NVP, and EFV, respectively.CONCLUSIONS: Overall, the proportion of patients with elevated TC on NRTI+PI and NRTI+NNRTI was similar, but with concurrently lowered HDL-c significantly less on NRTI+NNRTI. Patients on first-line NRTI+NNRTI were less likely to have dyslipidemia, had a lower TC/HDL-c ratio, and had a 2.09-fold chance of having an elevated (cardio-protective) HDL-c when compared to those on first-line PI containing ART. Prolonged follow-up is needed to show whether these differences will translate into a differential risk of CVD.

Publication Types:

• Meeting Abstracts

Keywords:

• Anti-HIV Agents
• Antiretroviral Therapy, Highly Active
• Cardiovascular Diseases
• Cholesterol
• Cholesterol, HDL
• Cross-Sectional Studies
• Drug Therapy, Combination
• HIV Infections
• HIV Seropositivity
• Humans
• Hyperlipidemias
• Lipids
• Oxazines
• Triglycerides
• drug therapy
• efavirenz
• therapy

Other ID:

• GWAIDS0024095

UI: 102263719

From Meeting Abstracts