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

ONE YEAR EFFECTS OF SWITCHING FROM HIV-1 PIs TO NEVIRAPINE ON METABOLIC ABNORMALITIES

Antiviral Therapy 1999; 4(Suppl. 2):55(abstract no.40)

JM Gatell, I Conget, L Lozano, R Casamitjana and E Martinez
Hospital Clinic, Barcelona, Spain

BACKGROUND: We have previously reported on the partial improvement of metabolic abnormalities associated with PI-containing regimens 6 months after switching to nevirapine.

OBJECTIVES: To assess the metabolic and anthropometric effects beyond 6 months of follow-up.

DESIGN: Physical examination [including measurements of body mass index (BMI) and waist/hip ratio (WHR)], fasting cholesterol, triglycerides, glucose, insulin, CD4 cells and plasma HIV-1 RNA were performed at baseline and every 3 months.

RESULTS: Twenty-three patients (12 men) have been followed for a median of 14 months (range: 13-17). Seventeen patients complained of increased abdominal girth (in 15 also of peripheral fat wasting) and six of peripheral fat wasting only. HIV-1 RNA had been <200 copies/ml a median of 9 months (range: 3-14) prior to switching. Hypertriglyceridaemia (Δ200 mg/dl) was present in 23 (100%), 6 (26%), and 4 (17%); hypercholesterolaemia (Δ200 mg/dl) in 18 (78%), 8 (35%), and 5 (22%); and impaired fasting glucose (Δ110 mg/dl) in 7 patients (30%), 1 (4%), and none (0%), at baseline, 6 and 12 months, respectively. One year after switching there was a significant improvement in cholesterol (30% decrease) (P=0.0001), triglycerides (62% decrease) (P=0.0001), glucose (21 % decrease) (P=0.002), and fasting insulin resistance index (57% decrease) (P=0.0001). Patients on stavudine (n=13) had lower 1 year decreases of cholesterol (–48 mg/dl) (P=0.01) and triglycerides (–180 mg/dl) (P=0.03) than those without stavudine (–104 and –375, respectively). Only one patient had a detectable viral load 6 months after switching. WHR significantly decreased from 0.91 to 0.83 (P=0.01). Despite subjective improvement, none admitted to have the body shaped as prior to body changes.

CONCLUSIONS: Our data confirm the long-term positive effects of replacing PIs by nevirapine on metabolic abnormalities while maintaining suppression of viral replication.

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