1st International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 26–28 June 1999 - San Diego, CA, USA

LIPID PROFILES IN PATIENTS ON RITONAVIR/INDINAVIR-CONTAINING SALVAGE REGIMENS

Antiviral Therapy 1999; 4(Suppl. 2):53(abstract no. 36)

M Youle¹, A Mocroft¹, M Johnson¹, S Madge¹, D Ross¹, I Tierney¹, M Fisher² and S Randerson^2
1Royal Free Centre for HIV Medicine, London; and ²Brighton Healthcare, Brighton, UK

BACKGROUND: Hyperlipidaemia is associated with the use of PIs.

OBJECTIVES: To evaluate the lipid profile of subjects receiving combinations of antiretroviral agents including indinavir/ritonavir.

DESIGN: Subjects who had previously taken PI containing regimens (both single and double) and who were commenced on salvage combinations including ritonavir/indinavir were monitored for changes in non-fasting serum lipids (triglyceride and cholesterol). The upper ranges of normal were 2.2 mmol/l for triglycerides and 6.5 mmol/l for cholesterol. Indinavir in doses of 600 or 800 mg every 12 h was taken with ritonavir 100, 200 or 400 mg every 12 h. Changes in serum lipids were analysed by intent to treat and the rate of change in lipids in patients with three or more values was analysed using methods of linear regression.

RESULTS: Sixty-three patients started various salvage regimens including ritonavir/indinavir. At start of treatment, median cholesterol was 5.1 mmol/l (n=32), and was significantly raised in two patients, while the median triglyceride was 2.1 mmol/l, and was significantly elevated in 15 patients. Thirty-six patients had three or more measurements during 32 weeks of follow-up, and 30 (93.4%) exhibited a median 52.9% rise in cholesterol and 88.5% rise in triglycerides P>0.0001). No correlation existed between dose of indinavir and rise in lipids. However, the area under the curve of cholesterol and triglycerides between the 100 mg every 12 h and the 400 mg every 12 h dose rose fourfold (P=0.0065), correlation coefficient CC 0.052978 (P=0.0009) and threefold (P=0.0318), CC 0.44066 (P=0.0071), respectively.

CONCLUSION: Switching from other PI-containing regimens to ritonavir/indinavir is associated with a significant rise in serum lipids directly related to the dose of ritonavir.

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