Lipid‐Lowering Efficacy and Safety After Switching to Atazanavir‐Ritonavir‐Based Highly Active Antiretroviral Therapy in Patients with Human Immunodeficiency Virus

BackgroundThe prevalence of atherosclerosis is higher in HIV-positive people, who also experience it earlier than the general population.ObjectivesTo assess and compare the prevalence of atherosclerosis evaluated by the intima-media thickness of carotid and femoral arteries, and by the ankle-brachial pressure index (ABPI) in HIV patients treated or not treated with protease inhibitors (PIs) and controls.MethodsEighty HIV+ subjects (40 using PIs and 40 not using PIs) and 65 controls were included in the study. Atherosclerosis was diagnosed by (carotid and femoral) ITM measurement and ABPI. Classical risk factors for atherosclerosis and HIV were compared between the groups by statistical tests. A p ≤ 0.05 was considered significant.ResultsAn IMT > P75 or the presence of plaque was higher in the HIV+ than in the control group (37.5% vs 19%, p = 0.04). Comparative analysis showed a significant difference (p=0.014) in carotid IMT between HIV+ with PIs (0.71 ± 0.28 mm), without PIs 0.63 ± 0.11 mm and, and controls (0.59 ± 0.11 mm). There was no significant difference in femoral IMT between the groups or in ABPI between HIV+ subjects and controls. However, a significant difference (p=0.015) was found between HIV+ patients not treated with PIs (1.17 [1.08 - 1.23]), and controls 1.08 [1.07 - 1.17]).ConclusionIn HIV patients, atherosclerosis is more prevalent and seems to occur earlier with particular characteristics compared with HIV-negative subjects.

show abstract

“…28,29 This may explain the absence of a significant difference in IMT between the patients treated and not treated with PIs in the present study.…”

Section: Discussionmentioning

confidence: 54%

Intima-Media Thickness in the Carotid and Femoral Arteries for Detection of Arteriosclerosis in Human Immunodeficiency Virus-Positive Individuals

Godoi¹,

Brandt²,

Lacerda³

et al. 2016

Arquivos Brasileiros De Cardiologia

View full text Add to dashboard Cite

show abstract

“…In addition, 33% more patients achieved their National Cholesterol Education Panel (NCEP) Adult Treatment Panel (ATP) III cholesterol goals, while no appreciable changes were noted in median CD4 lymphocyte count or in number of patients with undetectable HIV viral load. 23 The SWAN study was a 48-week, open-label trial involving HIV-positive patients with persisting virologic suppression who were receiving stable PI-based regimens and who were randomized 2:1 to switch to atazanavir (278 patients) or to continue to receive current PI treatment (141 patients). The proportion of randomized patients with confirmed virologic rebound through week 48 was significantly lower for those who switched to atazanavir than for those who received the comparator PI (7% versus 16%), while changes in CD4 cell count from baseline were comparable in the two treatment groups.…”

Section: Discussionmentioning

confidence: 99%

“…32 At the same time, substituting abacavir for PIs in subjects with persisting undetectable HIV viral load and HAART-associated dyslipidemia usually improves serum lipid concentrations and maintains virologic suppression. [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] However, recent or current, but not cumulative or past use of abacavir or didanosine was associated with an increased rate of myocardial infarction in 33,347 patients enrolled in the DAD Study. Relative rate was 1.9 with abacavir and 1.49 with didanosine compared with those with no recent use of these drugs, while rates were not significantly increased in subjects who stopped these agents more than 6 months previously compared with those who had never received these drugs.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Atazanavir-Ritonavir Plus Abacavir-Lamivudine or Tenofovir-Emtricitabine in Patients with Hyperlipidaemia Switched from a Stable Protease Inhibitor-Based Regimen Including One Thymidine Analogue

Calza

Manfredi²,

Colangeli³

et al. 2009

AIDS Patient Care and STDs

View full text Add to dashboard Cite

Randomized, open-label, prospective clinical trial assessing efficacy and safety on hyperlipidemia of a switching from a regimen including one protease inhibitor and one thymidine analogue to atazanavir/ritonavir plus abacavir/lamivudine or tenofovir/emtricitabine. Adult HIV-infected patients on their first antiretroviral therapy (of at least 48-week duration), including one protease inhibitor and zidovudine or stavudine, with stable immunovirologic features, and having diagnosis of persisting hyperlipidemia, were randomized to replace current treatment with atazanavir/ritonavir plus abacavir/lamivudine (arm A) or tenofovir/emtricitabine (arm B), and were followed for 48 weeks. Eighty-nine patients were enrolled: 42 patients were randomized to arm A, and 47 to arm B. At the end of the 48-week follow-up, incidence of virologic failure was comparable in both arms, and associated with a poor drug compliance. Increase in CD4 lymphocyte count was significantly higher in arm A after a 24-week study period (62.5 versus 39.2 x 10(6) cells/L; p < 0.05), while immunologic responses were comparable at the end of 48-week follow-up (91.5 versus 83.6; p > 0.05). A statistically significant reduction (-15.4%) in mean triglyceridaemia versus respective baseline values was reported in both groups (p < 0.05), without statistically significant difference between arm A and B. Similar results were reported for total cholesterol and low-density lipoprotein (LDL) cholesterol levels. Safety and tolerability profiles were comparable in both groups. Switching from a protease inhibitor- and thymidine analogue-based antiretroviral regimen to atazanavir/ritonavir plus abacavir/lamivudine or tenofovir/emtricitabine proved effective in the management of hyperlipidemia, without significant differences in lipid-lowering effect, virologic efficacy, and safety profile between these regimens.

show abstract

“…This change should be done in consultation with the provider who is managing the patients' ART. 118,119 Monitoring and Follow-up According to the European guidelines, recommendations for follow-up after beginning therapy "stem from consensus rather than evidencebased guidelines" and that "response to therapy can be assessed at 6-8 weeks from initiation or dose increases for statins, but response to fibrates and lifestyle may take longer." 48 For most patients, maximum LDL and triglyceride lowering is evident by 6 weeks after starting therapy.…”

Section: Switching Antiretroviral Therapymentioning

confidence: 99%

Lipid Management in Human Immunodeficiency Virus

Myerson¹

2015

Cardiology Clinics

View full text Add to dashboard Cite

Lipid‐Lowering Efficacy and Safety After Switching to Atazanavir‐Ritonavir‐Based Highly Active Antiretroviral Therapy in Patients with Human Immunodeficiency Virus

Cited by 29 publications

References 42 publications

Intima-Media Thickness in the Carotid and Femoral Arteries for Detection of Arteriosclerosis in Human Immunodeficiency Virus-Positive Individuals

Intima-Media Thickness in the Carotid and Femoral Arteries for Detection of Arteriosclerosis in Human Immunodeficiency Virus-Positive Individuals

Efficacy and Safety of Atazanavir-Ritonavir Plus Abacavir-Lamivudine or Tenofovir-Emtricitabine in Patients with Hyperlipidaemia Switched from a Stable Protease Inhibitor-Based Regimen Including One Thymidine Analogue

Lipid Management in Human Immunodeficiency Virus

Contact Info

Product

Resources

About