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

FACTORS ASSOCIATED WITH THE DEVELOPMENT OF HIGH SERUM TRIGLYCERIDE LEVELS IN PATIENTS RECEIVING TWO NRTI COMBINATIONS

Antiviral Therapy 2002; 7:L28 (abstract 40)

M Galli, C Gervasoni, F Adorni, M Piazza, P Morelli, E Gianelli, M Vaccarezza, A d’Arminio Monforte, A Ridolfo and M Moroni
Istituto di Malattie Infettive e Tropicali (IMIT), Università di Milano, Milano, Italy

OBJECTIVE: The role of nucleoside reverse transcriptase inhibitors (NRTI) in causing metabolic alterations is still debated. The aim of this study was to assess the risk of developing hypertriglyceridemia in patients treated with two NRTIs.

METHODS: The patients enrolled in the study were outpatients attending IMIT who, in March 1998 (T1), were receiving two NRTIs and had never used protease inhibitors (PIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) or any triple combination. The appearance of adipose tissue alterations (ATAs) and the risk of presenting triglyceride values >200/ml (HT) were assessed every 3 months. The patients contributed to the analysis for as long as they remained on two NRTIs. The risk of developing HT was assessed in a logistic regression model that included age, gender, modality of HIV transmission, CD4 cell count, the use of zidovudine vs stavudine, the use of lamivudine vs didanosine vs zalcitabine, and antiretroviral therapy (ART)-naïve status or otherwise at the beginning of the ongoing treatment at T1.

RESULTS: The cohort included 322 patients (46.6% females; median age: 34 years; 41.3% receiving stavudine at T1); 42.9% were subsequently switched to a triple combination. The median follow-up calculated from the beginning of the ongoing treatment at T1 was 1353 days (range 6-2952). The factors independently associated with the development of HT were male gender (OR 1.76, 95% CI 1.09-2.84, P=0.021) and stavudine treatment (OR 2.37, 95% CI 1.46-3.84, P=0.001). The frequency of HT was not significantly higher in the patients who developed ATAs than in those who did not, but tended to be more frequent in those with lipoatrophy. Taking the patients receiving zidovudine+lamivudine as the reference category, the risk of HT revealed by univariate analysis was 1.74 (95% CI 1.09-2.79) in the patients treated with stavudine+ lamivudine and 4.61 (95% CI 1.90-11.21) in those treated with stavudine+didanosine.

CONCLUSIONS: HT is a frequent finding also in patients on ART who have never been treated with PI or triple combinations. These results confirm and extend our previous findings concerning the increased risk of HT in patients receiving stavudine (J Acquir Immune Defic Syndr 2002 Jan 1;29(1):21-31).

Presenting author: M Galli

2002-09-22
40

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