Body Habitus Changes and Metabolic Alterations in Protease Inhibitor–Naive HIV-1–Infected Patients Treated With Two Nucleoside Reverse Transcriptase Inhibitors

Galli, Massimo; Ridolfo, Anna Lisa; Adorni, Fulvio; Gervasoni, Cristina; Ravasio, Laura; Corsico, Laura; Gianelli, Erika; Piazza, Manuela; Vaccarezza, Mauro; Monforte, Antonella d’Arminio; Moroni, Mauro

doi:10.1097/00126334-200201010-00003

Cited by 68 publications

(68 citation statements)

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“…5% of patients* wz patients on non-PI-containing regimens, suggesting that NFV use may be more likely to be associated with accelerated atherosclerosis, and hence greater risk of coronary artery disease (CAD) [24]. The increase in lipids observed in the d4T/3TC/NFV group was greater than that observed in the COM/NFV group, confirming the results of earlier clinical trials that showed that d4T induces increases in cholesterol and triglycerides that are additional to those caused by concurrently administered PIs [25,26]. The value of TZV with respect to facilitating adherence and enhancing patient satisfaction over more complex HAART regimens has been reported elsewhere [27,28].…”

Section: Discussionsupporting

confidence: 71%

A prospective, 96‐week study of the impact of Trizivir^®, Combivir^®/nelfinavir, and lamivudine/stavudine/nelfinavir on lipids, metabolic parameters and efficacy in antiretroviral‐naive patients: effect of sex and ethnicity

et al. 2006

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To compare the lipid and metabolic effects, efficacy, and safety of twice-daily regimens of Trizivir s (abacavir 300 mg/lamivudine 150 mg/zidovudine 300 mg triple nucleoside tablet; TZV), Combivir s (lamivudine 150 mg/zidovudine 300 mg combination tablet; COM) 1 nelfinavir (NFV), and stavudine (d4 T) 1 lamivudine (3TC) 1 NFV. Study designAn international, phase 4, open-label, parallel-group, 34-centre study was conducted in 254 nondiabetic, antiretroviral-naive, HIV-infected out-patients with an HIV-1 RNA level of 41000 HIV-1 RNA copies/mL and 200 000 copies/mL and a CD4 cell count of 450 cells/mL. MethodsPatients were randomized 1 : 1 : 1 to TZV twice daily (n 5 85), COM/NFV 1250 mg twice daily (n 5 88), or d4T 40 mg 1 3TC 150 mg 1 NFV 1250 mg twice daily (n 5 81) for 96 weeks. Treatments were compared using analysis of covariance (ANCOVA) with regard to changes from baseline in fasting lipids in the total population and in sex and ethnic subgroups. The proportions of patients achieving HIV-1 RNA o50 and o400 copies/mL were compared using a 95% confidence interval (CI) on the difference between proportions. ResultsThe study population was diverse (50% female, 40% black and 37% Hispanic). Mean baseline lowdensity lipoprotein (LDL) cholesterol was 99 mg/dL, HIV-1 RNA was 4.43 log 10 copies/mL and CD4 cell count was 355 cells/mL. At week 96, fasting LDL cholesterol changed minimally in the TZV group [least square mean (LSM) change from baseline, À 8 mg/dL], but increased with d4T/3TC/NFV and COM/NFV ( 1 29 and 1 19 mg/dL, respectively; Po0.001 versus TZV). Week 96 LDL-cholesterol levels were significantly lower in the TZV group than in the other two treatment groups in women and men and lower than in the d4T/3TC/NFV group in Hispanic and black patients. In black patients, the week-96 LSM change from baseline in LDL cholesterol was significantly less with TZV than with d4T/3TC/NFV ( 1 1 vs 1 39 mg/dL; P 5 0.003). Total cholesterol4200 mg/dL occurred in a smaller proportion of patients receiving TZV (30%) compared with COM/NFV (50%) or d4T/3TC/NFV (60%; P 5 0.005 vs TZV). High-density lipoprotein (HDL) cholesterol did not change markedly with any treatment. Although triglycerides increased, they changed least in women and Hispanic patients receiving TZV. Virological and CD4 responses to the treatments were similar in the total population and in the subgroups. Diarrhoea was reported more often in the NFV arms and nausea in the ZDV arms. 85 ConclusionsOver 96 weeks, TZV twice daily has significantly less effect on LDL cholesterol than COM/NFV or d4T/3TC/NFV twice daily, especially in women and black patients, and is associated with similar virological and CD4 responses.

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Section: Discussionsupporting

confidence: 71%

A prospective, 96‐week study of the impact of Trizivir^®, Combivir^®/nelfinavir, and lamivudine/stavudine/nelfinavir on lipids, metabolic parameters and efficacy in antiretroviral‐naive patients: effect of sex and ethnicity

et al. 2006

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“…Several studies have found that stavudine was more involved in the occurrence of lipid derangements as compared with other NRTIs [22,23]. We found no difference in lipid profiles when participants on stavudine were compared to those on zidovudine.…”

Section: Discussioncontrasting

confidence: 63%

First-line antiretroviral therapy and dyslipidemia in people living with HIV-1 in Cameroon: a cross-sectional study

Yone

Betyoumin²,

Kengne

et al. 2011

AIDS Res Ther

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BackgroundData on lipid profile derangements induced by antiretroviral treatment in Africa are scarce. The aim of this study was to determine the prevalence and characteristics of lipid profile derangements associated with first-line highly active antiretroviral therapy (ART) among Cameroonians living with human immunodeficiency virus (HIV) infection.MethodsThis cross-sectional study was conducted between November 2009 and January 2010, and involved 138 HIV patients who had never received ART (ART-naive group) and 138 others treated for at least 12 months with first line triple ART regimens that included nevirapine or efavirenz (ART group). Lipid profile was determined after overnight fast and dyslipidemia diagnosed according to the US National Cholesterol Education Program III criteria. Data comparison used chi-square test, Student t-test and logistic regressions.ResultsThe prevalence of total cholesterol ≥ 200 mg/dl was 37.6% and 24.6% respectively in ART group and ART-naive groups (p = 0.019). The equivalents for LDL-cholesterol ≥ 130 mg/dl were 46.4% and 21% (p ≤ 0.001). Proportions of patients with total cholesterol/HDL-cholesterol ratio ≥ 5 was 35.5% in ART group and 18.6% in ART-naive group (p ≤ 0.001). The distribution of HDL-cholesterol and triglycerides was similar between the two groups. In multivariable analysis adjusted for age, sex, body mass index, CD4 count and co-infection with tuberculosis, being on ART was significantly and positively associated with raised total cholesterol, LDL-cholesterol and TC/HDL cholesterol. The adjusted odd ratios (95% confidence interval, p-value) ART-treated vs. ART-naïve was 1.82 (1.06-1.12, p = 0.02) for TC ≥ 200 mg/dl; 2.99 (1.74-5.15), p < 0.0001) for LDL-cholesterol ≥ 130 mg/dl and 1.73 (1.04-2.89, p = 0.03) for TC/HDL-cholesterol ≥ 5.ConclusionsFirst-line antiretroviral therapy that includes nonnucleoside reverse transcriptase inhibitors is associated with pro-atherogenic adverse lipid profile in people with HIV-1 infection compared to untreated HIV-infected subjects in Yaounde. Lipid profile and other cardiovascular risk factors should be monitored in patients on such therapy so that any untoward effects of treatments can be optimally managed.

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“…The advent of combined antiretroviral therapy (cART) increased survival, and resulted in the emergence of complications nonexistent or not perceived, until then, and thought to be drug-related adverse effects. These complications included body fat redistribution, increased fat mass, and changes in circulating lipids and glucose metabolism, all contributing to increased cardiovascular risk (CVR) (5)(6)(7)(8)(9)(10)(11)(12).…”

mentioning

confidence: 99%

Prevalence of obesity and cardiovascular risk in patients with HIV/AIDS in Porto Alegre, Brazil

Kroll

Sprinz

Leal

et al. 2012

Arq Bras Endocrinol Metab

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Objective: The aim of this study was to discover the prevalence of overweight, obesity and cardiovascular risk in our HIV/AIDS outpatients according to sex, antiretroviral therapy and other variables. Subjects and methods: Patients underwent an anthropometric assessment. Body mass index and waist circumference were used to classify their nutritional status and their cardiovascular risk. Results: The majority of the 345 patients (58.8%) were males. Obesity was detected in 8.3% of them; 34.2% were overweight, and 5.2% malnourished. Near half of them (51.3%) had some cardiovascular risk, with increased risk in 24.6% of them, and substantially increased risk in 26.7% of them. Conclusions: Overweight and obesity were highly prevalent. Women were more frequently obese (OR = 3.53; IC 95%, 1.47 < OR < 8.69), and their cardiovascular risk was often higher (OR = 6.97; IC 95%, 4.16 < OR < 11.76). The prevalence of obesity and cardiovascular risk did not change according to antiretroviral therapy or other variables. Arq Bras Endocrinol Metab. 2012;56(2):137-41 Keywords Overweight; obesity; body mass index; HIV; acquired immunodeficiency syndrome RESUMO Objetivo: Conhecer a prevalência de sobrepeso, obesidade e risco cardiovascular em nossos pacientes ambulatoriais com HIV/AIDS de acordo com o sexo, tratamento antirretroviral e outras variáveis. Sujeitos e métodos: Os pacientes foram submetidos à avaliação antropométri-ca. O índice de massa corporal e a medida da circunferência da cintura foram utilizados para classificar o estado nutricional e o risco cardiovascular. Resultados: A maior parte dos 345 pacientes (58,8%) era do sexo masculino. A obesidade foi detectada em 8,3% deles; 34,2% tinham sobrepeso e 5,2%, desnutrição. Quase a metade (51,3%) apresentou algum risco cardiovascular, com risco elevado em 24,6% e muito elevado em 26,7%. Conclusões: O sobrepeso e a obesidade têm elevada prevalência. As mulheres são mais frequentemente obesas (OR = 3,53; IC 95%, 1,47 < OR < 8,69) e seu risco cardiovascular é frequentemente mais alto (OR = 6,97; IC 95%, 4,16 < OR < 11,76). A prevalência de obesidade e de risco cardiovascular não se alterou conforme o tratamento antirretroviral ou outras variáveis. Arq Bras Endocrinol Metab. 2012;56(2):137-41 Descritores

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Body Habitus Changes and Metabolic Alterations in Protease Inhibitor–Naive HIV-1–Infected Patients Treated With Two Nucleoside Reverse Transcriptase Inhibitors

Cited by 68 publications

References 30 publications

A prospective, 96‐week study of the impact of Trizivir^®, Combivir^®/nelfinavir, and lamivudine/stavudine/nelfinavir on lipids, metabolic parameters and efficacy in antiretroviral‐naive patients: effect of sex and ethnicity

A prospective, 96‐week study of the impact of Trizivir^®, Combivir^®/nelfinavir, and lamivudine/stavudine/nelfinavir on lipids, metabolic parameters and efficacy in antiretroviral‐naive patients: effect of sex and ethnicity

First-line antiretroviral therapy and dyslipidemia in people living with HIV-1 in Cameroon: a cross-sectional study

Prevalence of obesity and cardiovascular risk in patients with HIV/AIDS in Porto Alegre, Brazil

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Body Habitus Changes and Metabolic Alterations in Protease Inhibitor–Naive HIV-1–Infected Patients Treated With Two Nucleoside Reverse Transcriptase Inhibitors

Cited by 68 publications

References 30 publications

A prospective, 96‐week study of the impact of Trizivir®, Combivir®/nelfinavir, and lamivudine/stavudine/nelfinavir on lipids, metabolic parameters and efficacy in antiretroviral‐naive patients: effect of sex and ethnicity

A prospective, 96‐week study of the impact of Trizivir®, Combivir®/nelfinavir, and lamivudine/stavudine/nelfinavir on lipids, metabolic parameters and efficacy in antiretroviral‐naive patients: effect of sex and ethnicity

First-line antiretroviral therapy and dyslipidemia in people living with HIV-1 in Cameroon: a cross-sectional study

Prevalence of obesity and cardiovascular risk in patients with HIV/AIDS in Porto Alegre, Brazil

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Resources

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A prospective, 96‐week study of the impact of Trizivir^®, Combivir^®/nelfinavir, and lamivudine/stavudine/nelfinavir on lipids, metabolic parameters and efficacy in antiretroviral‐naive patients: effect of sex and ethnicity

A prospective, 96‐week study of the impact of Trizivir^®, Combivir^®/nelfinavir, and lamivudine/stavudine/nelfinavir on lipids, metabolic parameters and efficacy in antiretroviral‐naive patients: effect of sex and ethnicity