4th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 22-25 September 2002, San Diego, CA, USA

ANTIRETROVIRAL THERAPY-INDUCED CHANGES IN LIPOPROTEIN SUBCLASS PHENOTYPE: COMPARISON OF PROTEASE INHIBITOR AND NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITOR REGIMENS

Antiviral Therapy 2002; 7:L9 (abstract 14)

GL Simon, AP Liappis, SL Granger, AD Roberts, SZ Schuck, JR Simon, JE Clarke and DM Parenti
George Washington University, Washington D.C., USA

OBJECTIVE: To compare the lipoprotein subclass phenotypes for HIV-infected patients receiving antiretroviral therapy (ART)-utilizing regimens with and without protease inhibitors.

METHODS: Plasma obtained from fasting individuals who were receiving ART with nucleoside reverse transcriptase inhibitors (NRTIs) and either nelfinavir or efavirenz was harvested from venous blood and frozen (–70°) within 30 minutes. Samples were obtained at baseline and after 16 weeks of therapy. Lipoprotein subclasses were determined by NMR spectroscopy based on particle concentration and size. The results were analysed using a paired t-test.

RESULTS: In the nelfinavir group cholesterol rose by 34.5%, triglycerides by 26.5%, LDL by 45.0% and HDL by 15.5%. Among efavirenz recipients cholesterol rose by 22.0%, triglycerides by 38.2%, LDL by 17.0% and HDL by 35.4%. In each case this increase from baseline was statistically significant. Comparing the nelfinavir and efavirenz recipients there was no statistically significant differences in the magnitude of the cholesterol or triglyceride rise. However, the differences for both LDL and HDL were significant (P<0.05). Subclass analysis revealed an even more striking difference. Among the HDL subclasses, large particle HDL is associated with a decreased coronary artery risk whereas increases in small particle HDL portends an increased risk of coronary artery disease. Among nelfinavir recipients, large HDL rose by 8.2% whereas small HDL rose by 44.8%. In contrast, in the efavirenz group large HDL rose by 40.9% (P<0.05 compared to the nelfinavir group) and small HDL by 25.2%. For LDL the main difference between the two groups was the number of LDL particles which increased by 45.0% in the nelfinavir group and 11.7% in the efavirenz group (P<0.05). The number of LDL particles is directly correlated with coronary artery disease risk.

CONCLUSIONS: Among HIV-infected patients, the administration of antiretroviral therapy results in increases in lipids and lipoproteins. Subclass analysis revealed that patients who received PI-containing regimens developed a pro-atherogenic lipoprotein phenotype whereas regimens that included only NRTIs and a non-nucleoside reverse transcriptase inhibitor (NNRTI) were associated with a relatively lower risk lipoprotein phenotype.

Presenting author: GL Simon

2002-09-22
14

Copyright © 2002 - International Medical Press Ltd.. Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Medical Editor, International Medical Press, 36 St Mary-at-Hill, London EC3R 8DU, United Kingdom.