3rd International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 23-26 October 2001, Athens, Greece

INCONSISTENT EFFECTS OF LIPID-LOWERING DRUGS IN THE MANAGEMENT OF HIV-ASSOCIATED DYSLIPIDEMIAS

Antiviral Therapy 2001; 6(Suppl. 4):21 (abstract no. 30)

F Visnegarwala, P Sajja, MC Rodriguez-Barraddas, M Maldonado, O Ong, K Kohil and AC White Jr.
Baylor College of Medicine, Houston, Tex., USA

BACKGROUND: Despite limited data lipid-lowering drugs (LLD) are recommended in HIV patients based on guidelines for other diseases.

OBJECTIVE: To evaluate the efficacy and safety of LLD in management of HIV-dyslipidemia in clinical setting.

METHODS: Patients with highly active antiretroviral therapy (HAART)-associated dyslipidemia treated with LLD were identified from: (1) prospective database at metabolic clinic at Thomas Street Clinic; (2) existing VA database. Among the first 103 consecutive patients who had fasting lipid profiles recorded pre- and post-LLD, additional data were reviewed. In addition to dietary advice the LLD were used in a stepwise fashion as recommended in the NCEP guidelines. The lipid lowering effect of each LLD regimen was recorded.

RESULTS: Of 103 patients, 92% were men, 45% women, 36% AA, 16% H, median age 49 years, 50% had AIDS, 21% had new/existing DM, and 60% had ≥2 cardiovascular risk factors. 82 % on protease inhibitors (31% on ritonavir). Thirty-three and 15 patients received second and third LLD regimen, respectively. Median follow-up: 70 weeks. Baseline mean (±SD) T_CHOL was 281 (100), triglycerides 836 (114), HDL 36 (13), LDL 138 (53). Statins used: atorvasta tin 49%, pravastatin, 20%, simvastatin 19%, and lovastatin 12%; fibrates (FIB): gemfibrozil 90%, fenofibrate 10%. The decreases in triglycerides and T_CHOL with use of fibrates and T_CHOL with statins was significant, but no significant increase in HDL was seen. Among patients continuing protease inhibitors, only (16%) reached target decrease in LDL and T_CHOL despite LLD for >52 weeks. Non-adherence was documented in 10/64 (15%) patients stopping first LLD. There were no discontinuations due to AEs, but 6/48 had an increase in CPK >500 U/l. On multivariate logistic regression analysis only lower age (OR: 1.08; CI 1-1.2; P=0.04); and stopping protease inhibitors (OR 10.7; 56-2; P<0.01) were associated with significant reduction in T_CHOL.

CONCLUSIONS: Though well tolerated in HIV dyslipidemia, the overall response to LLD was modest. Significant reduction in both T_CHOL and triglycerides with fibrates may make them an attractive first choice for management of HIV-dyslipidemia. Only one-sixth of patients continuing protease inhibitors achieved the recommended T_CHOL target.

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