AEGiS-9CROI: Distinguishable Lipid Profiles between PI and NNRTI Therapy May Carry Different Risk of Cardiovascular Disease (CVD).

9th Conference on Retroviruses and Opportunistic Infections

Seattle, Washington - February 24 -February 28, 2002

Distinguishable Lipid Profiles between PI and NNRTI Therapy May Carry Different Risk of Cardiovascular Disease (CVD).

Conf Retroviruses Opportunistic Infect 2002 Feb 24-28;9:abstract no. 34
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, The DAD Study Group; 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-naïve 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-naïve, 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-naïve, 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-naïves, 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.

Keywords: Anti-HIV Agents, Lipoproteins, HDL Cholesterol, Cardiovascular Diseases, Reverse Transcriptase Inhibitors, Triglycerides, HIV Protease Inhibitors, HIV Infections, Hyperlipidemia, Antiretroviral Therapy, Highly Active, Drug Therapy, Combination, Cross-Sectional Studies, Human, therapy, drug therapy

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Copyright © 2002 - Foundation for Retrovirology and Human Health. Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Foundation for Retrovirology and Human Health. Licensed (AIDSLINE) from National Library of Medicine.