[O-10] The rate at which therapy-naïve patients develop metabolic syndrome when treated and its association with different components of antiretroviral therapy: the Swiss HIV Cohort Study

9th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV

19-21 July 2007, Sydney, Australia

THE RATE AT WHICH THERAPY-NAÏVE PATIENTS DEVELOP METABOLIC SYNDROME WHEN TREATED AND ITS ASSOCIATION WITH DIFFERENT COMPONENTS OF ANTIRETROVIRAL THERAPY: THE SWISS HIV COHORT STUDY

Antiviral Therapy 2007; 12(Suppl. 2):L10 (abstract no. O-10)

J Young¹, T Glass¹, R Weber², E Bernasconi³, M Rickenbach⁴, HJ Furrer⁵, M Cavassini⁴, P Vernazza⁶, B Hirschel⁷, M Battegay¹ and HC Bucher¹
¹University Hospital Basel, Switzerland; ²University Hospital Zurich, Switzerland; ³Regional Hospital Lugano, Switzerland; ⁴University Hospital Lausanne, Switzerland; ⁵University Hospital Bern, Switzerland; ⁶Canton Hospital St Gallen, Switzerland; ⁷University Hospital Geneva, Switzerland

OBJECTIVES: To estimate associations between components of antiretroviral therapy and the rate at which therapy-naïve patients develop metabolic syndrome (MS) when treated.

METHODS: In April 2000, a cardiovascular risk assessment became part of each biannual cohort visit. We consider progression to MS (under the 2005 International Diabetes Federation definition) using discrete time survival analysis. Our model is hierarchical with 16 drug components and four drug classes as first and second levels, respectively, and it allows for residual effects not otherwise included in the model. Our model adjusts for age, sex, transmission by drug use; for BMI, CD4 count and viral load when starting therapy; for smoking status at each visit; and for variation in the time between visits.

RESULTS: As of 31 December 2006, 1,218 patients with multiple visits and without MS at their first visit were followed for a median of 27 months; 242 (20%) developed MS at a rate of 7.5 cases per 100 patient years. five-hundred and twenty-one patients (43%) used only PI-based therapy, 465 (38%) used only NNRTI-based therapy, and 232 (19%) used both. Among NRTIs, progression to MS appears relatively unlikely with the use of didanosine ([odds ratio] 0.82, [95% CI] 0.64–1.05 [per 6 months use]) and relatively likely with the use of stavudine (1.07, 0.88–1.31). Among PIs, MS appears relatively unlikely with the use of atazanavir, either as a single PI (0.37, 0.18–0.78) or boosted with ritonavir (0.76, 0.48–1.21), and relatively likely with the use of indinavir boosted with ritonavir (1.17, 0.83–1.65). MS appears relatively unlikely with both NNRTIs (efavirenz 0.90, 0.74–1.10; nevirapine 0.82, 0.62–1.10). These estimates from a hierarchical model are less exaggerated than estimates from a conventional model.

CONCLUSIONS: Each drug class has specific drugs that seem relatively unlikely to lead to MS.

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2007-07-24
O-10

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