Switching antiretroviral therapy to minimize metabolic complications

Lake, Jordan E.; Currier, Judith S.

doi:10.2217/hiv.10.47

Cited by 9 publications

(5 citation statements)

References 80 publications

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“…[27, 34–36] Darunavir and atazanavir have been found to cause fewer metabolic side effects than lopinavir, ritonavir, and indinavir. [37–38] Some studies have reported an association between increased cIMT and isolated systolic hypertension. [39–41]…”

Section: Discussionmentioning

confidence: 99%

Echocardiography and carotid intima–media thickness among asymptomatic HIV-infected adolescents in Thailand

Chanthong

Lapphra

Saihongthong

et al. 2014

Aids

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Section: Discussionmentioning

confidence: 99%

Echocardiography and carotid intima–media thickness among asymptomatic HIV-infected adolescents in Thailand

Chanthong

Lapphra

Saihongthong

et al. 2014

Aids

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“…One should further note, that patented TAF/FTC is still recommended as preferred option for the initiation of antiretroviral therapy [ 18 ], which has shown superior renal and bone safety compared to TDF/FTC [ 43 – 45 ]. Therefore, a change of treatment routine should not solely focus on the potential cost-savings but also on medical concerns, such as acute toxicities or treatment failures [ 46 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

Cost-savings and potential cost-savings through the distribution of generic antiretroviral drugs within the statutory health insurance market of Germany between January 2017 and June 2019

Lottes

Bremer

Prugger

et al. 2022

BMC Health Serv Res

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Background Recent patent losses for antiretroviral drugs (ARV) have led to the debate of cost-saving through the replacement of patented drugs with generic drugs. The split of recommended single-tablet regimens (STR) into their single substance partners is one of the considerations mentioned in said debate. Particularly, generic tenofovir disoproxil/emtricitabine (TDF/FTC) is expected to hold untapped cost-saving potential, which may curb increasing overall expenditures for combined antiretroviral therapy (cART) within the statutory health insurance (SHI) of Germany. Methods Data of ARV reimbursed by the SHI were used to describe the trends of defined daily doses (DDD) as well as the revenue within the German ARV market. They were also used to determine the cost-savings of moving to generic drugs. The time period observed was between January 2017 and June 2019. The potential cost-savings were determined with following assumption in mind: the maximum possible use of generic ARV, including 1) the split of STR and replacing all substance partners with generic ones, and 2) replacing patented tenofovir alafenamide/emtricitabine (TAF/FTC) with generic TDF/FTC. Results Throughout the observation period, the DDD of generic ARV increased nearly five-fold while their revenue increased more than four-fold. Total cost-saving showed a sharp increase over the same period, with generic TDF/FTC accounting for a share of around 70%. The largest potential cost-saving could have been achieved through replacing patented TAF/FTC with generic TDF/FTC, peaking at nearly 10% of total revenue, but showing decreasing trends in general. Conclusion The progressive distribution of generic ARV ensured increasing cost-savings, but consequently curbed the potential cost-savings. Unique price reductions of generic TDF/FTC have played a pivotal role for these effects. In any case, substituting with generic ARV should not fail to adhere to the treatment guidelines and continue to consider the medical requirements for the treatment.

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“…There is abundant literature on the improvement of lipid profile of people with HIV subsequent substitution of NNRTI or NRTI for PI in the treatment regimens. 18 We are not aware of a study that has examined the effects of PI on lipid profile of patients initially treated with NNRTI. The current study was conducted in a setting where virtually all treated HIV-1 patients are almost always started on an NNRTI-based regimen as a first-line therapy, and shifted to PI-based regimens only after failure of the first-line therapy.…”

Section: Discussionmentioning

confidence: 99%

Dyslipidaemia in HIV-1-infected patients receiving protease inhibitors after initial treatment with first-line-based non-nucleoside reverse transcriptase inhibitors: a cross-sectional study

et al. 2012

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ObjectivesLipid abnormalities associated with antiretroviral therapy in people with HIV infection are more frequent with protease inhibitors (PI)-based regimens. Whether effects extend to patients receiving a PI subsequent to failure on non-nucleoside reverse-transcriptase inhibitors (NNRTI)-based regimen is still unknown. We investigated the effects of secondary treatment with a PI on the lipid profile in a group of patients with HIV infection in Cameroon.DesignThis was a cross-sectional study.SettingThis study was carried out at the registered centre for HIV treatment of the Yaounde Jamot Hospital in Cameroon.ParticipantsParticipants were consecutively recruited between November 2009 and January 2010. There were 138 HIV-1 patients on initial treatment with an NNRTI regimen and 66 HIV patients on secondary treatment with a PI for at least 12 months. Lipid abnormalities were based on the National Cholesterol Education Program, Adult Treatment Panel III criteria.Outcome measuresLevels of lipid parameters among patients on PI and NNRTI.ResultsMedian (IQR) levels (mg/dl), NNRTI-treated versus PI-treated patients were 185 (149–225) and 189 (147–244) for total cholesterol, 46 (27–66) and 42 (28–82) for high-density lipoprotein (HDL)-cholesterol, 121 (90–169) and 126.9 (71–176) for low-density lipoprotein (LDL)-cholesterol, 134 (98–174) and 138 (111–167) for triglycerides, and 4.3 (2.9–6.2) and 5.1 (2.6–7.9) for total/HDL-cholesterol ratio (all p>0.32). The most frequent lipid abnormality in the two groups was high LDL-cholesterol (46.4% (NNRTI) vs 54.5% (PI)). The occurrence of lipid abnormalities was similar in the two groups (all p>0.29).ConclusionsThe use of PI does not appear to deteriorate the lipid profile of HIV patients above and beyond abnormalities induced by an unsuccessful initial treatment with NNRTI. Monitoring of lipid profile during HIV treatment regardless of the regimens would improve timely detection and management of abnormalities, to mitigate related risks.

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Switching antiretroviral therapy to minimize metabolic complications

Cited by 9 publications

References 80 publications

Echocardiography and carotid intima–media thickness among asymptomatic HIV-infected adolescents in Thailand

Echocardiography and carotid intima–media thickness among asymptomatic HIV-infected adolescents in Thailand

Cost-savings and potential cost-savings through the distribution of generic antiretroviral drugs within the statutory health insurance market of Germany between January 2017 and June 2019

Dyslipidaemia in HIV-1-infected patients receiving protease inhibitors after initial treatment with first-line-based non-nucleoside reverse transcriptase inhibitors: a cross-sectional study

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