AEGiS-07CROI: Partial improvement of lipodystrophy after switching from HIV-1 protease inhibitors (PI) to efavirenz (EFV).

7th Conference on Retroviruses and Opportunistic Infections

San Francisco, CA - January 30 -February 4, 2000

PARTIAL IMPROVEMENT OF LIPODYSTROPHY AFTER SWITCHING FROM HIV-1 PROTEASE INHIBITORS (PI) TO EFAVIRENZ (EFV).

Conf Retroviruses Opportunistic Infect 2000 Jan 30-Feb 2; 7:84 (abstract no. 48)

P. Viciana, A. Alarcon, D. Martin, P. Serrano, L. F. Lopez-Cortes, E. Cordero, And M. J. Gomez-Vera
Hosp. Univ. Virgen del Rocdotlessio, Seville, Spain

OBJECTIVES: To assess viral and inmune response, and changes in fat redistribution and metabolic abnormalities, in PI recipients with lipodystrophy, after switch from PI to EFV in NNRTI-naïve persons.

PATIENTS AND METHODS: 39 consecutive HIV-infected patients on PI therapy with sustained virological suppression (<200 copies/ml) for at least 6 months (median: 11 months), and fat redistribution, replaced PI with EFV. Nucleoside analogue therapy was unchanged. Participants were assessed at day 0 and every 3 months with measurements of body mass index (BMI), waist:hip ratio (WHR), face photography and a questionnaire of subjective body changes was complimented by the patient. Fasting cholesterol, HDL-cholesterol, LDL-cholesterol, triglyceride, glycemia, CD4+ cells and viral load were performed at baseline, 1, 2, 3, 4, 6, 9 and 12 months. For de analysis VL below limit detection (BLD)= 20 copies/ml.

RESULTS: Fifteen women and 24 men were enrolled, and completed 6 months of follow-up. Median duration of previous PI-containing regimen was 17 months (IQR, 13-21 months). Nucleoside therapy with d4T and 3TC was present in 34 (87.1%) patients. Viral load was below 200 copies/ml in 92.3% and below 20 copies/ml in 81% of patients at day 0. At month 6 VL was BLD in 82.3%, and <200 in 91.1%. Median CD4 count arise from 475 cells/µl (IQR, 301-604 cells/µl) trough 601cells/µl (IQR, 407-895 cells/µl). Most of patients (76%) subjectively reported a partial improvement in their body shape (although never as prior status) and WHR decrease from 0.94 to 0.93 (p=ns). However, BMI did not change (21.96 versus 22.06 kg/m²) and metabolic parameters showed a slightly impairment: mean triglycerides arise from 169 mg/dl at baseline to 201 mg/dl at month 6, cholesterol 202 mg/dl to 209 mg/dl, HDL cholesterol 36 mg/dl to 50 mg/dl, LDL cholesterol 113 mg/dl to 117 mg/dl and glucose 85 mg/dl to 92 mg/dl.

CONCLUSIONS: The strategy of substitution from PI to EFV maintains virological and inmunological response, but only a slightly reduction in fat redistribution. Mild elevations in lipids may also occur during the first 6 months.

Keywords: AEGIS, HIV Protease Inhibitors, Lipodystrophy, Oxazines, Viral Load, CD4 Lymphocyte Count, Reverse Transcriptase Inhibitors, Diabetes Mellitus, Lipoatrophic, Lamivudine, Triglycerides, Stavudine, efavirenz, Human, Female, Male, AIDS

2000-01-30
48

Copyright © 2000 - Foundation for Retrovirology and Human Health (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Foundation for Retrovirology and Human Health. Licensed from National Library of Medicine.