Lipid profiles for nevirapine vs. atazanavir/ritonavir, both combined with tenofovir disoproxil fumarate and emtricitabine over 48 weeks, in treatment-naive HIV-1-infected patients (the ARTEN study)
Por:
Podzamczer, D, Andrade-Villanueva, J, Clotet, B, Taylor, S, Rockstroh, JK, Reiss, P, Domingo, P, Gellermann, HJ, de Rossi, L, Cairns, V, Soriano, V
Publicada:
1 jul 2011
Resumen:
Objectives
Dyslipidaemic effects of antiretrovirals (ARVs) may contribute to increased cardiovascular risk (CR) in HIV-1-infected patients. The ARTEN (atazanavir/ritonavir on a background of tenofovir and emtricitabine vs. nevirapine on the same background, in naive HIV-1-infected patients) study compared prospectively ritonavir-boosted atazanavir (ATZ/r) 300 mg/100 mg once daily (qd) with immediate release nevirapine (NVP) 200 mg twice daily or 400 mg qd, each combined with fixed-dose tenofovir 300 mg/emtricitabine 200 mg qd in 569 ARV-naive HIV-1-infected patients. Lipid profiles and CR from baseline to week 48 are reported.
Methods
Changes from baseline to week 48 in fasting plasma levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), TC:HDL-c ratio, apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB) and total triglycerides (TG) were determined. The Framingham algorithm was used to estimate CR. Analysis was by intention-to-treat (ITT) with last observation carried forward (LOCF) for missing data.
Results
At week 48, NVP treatment resulted in significantly greater mean increases from baseline in TC (24.4 vs. 19.6 mg/dL; P=0.038), HDL-c (9.7 vs. 3.9 mg/dL; P < 0.0001), LDL-c (15.0 vs. 10.4 mg/dL; P=0.011) and ApoA1 (0.18 vs. 0.08 g/L; P < 0.0001) but not ApoB (0.02 vs. 0.02 g/L) compared with ATZ/r treatment. ATZ/r use was associated with higher mean TG increases (27.80 vs. 0.02 mg/dL; P=0.0001). Significantly greater mean decreases in TC:HDL-c and ApoB/ApoA ratios were observed with NVP vs. ATZ/r (P=0.0001 and P=0.008, respectively). Framingham CR scores were low and comparable between the arms, with only a slight mean increase from baseline to week 48 of 0.70 for NVP and 0.80 for ATZ/r [difference -0.069; 95% confidence interval (CI) -0.61 to 0.46; P=0.80].
Conclusions
In ARV-naive patients with low CR at the outset, NVP showed a potentially less atherogenic lipid profile compared with ATZ/r.
Filiaciones:
Podzamczer, D:
Hosp Univ Bellvitge, Infect Dis Serv, HIV Unit, Barcelona 08907, Spain
Andrade-Villanueva, J:
Antiguo Hosp Civil Guadalajara, Guadalajara, Jalisco, Mexico
Clotet, B:
Hosp Badalona Germans Trias & Pujol, Barcelona, Spain
IrsiCaixa Fdn, Barcelona, Spain
Taylor, S:
Birmingham Heartlands Hosp, Dept Sexual Hlth & HIV Med, Birmingham B9 5ST, W Midlands, England
Rockstroh, JK:
Univ Bonn, Dept Med, D-5300 Bonn, Germany
Reiss, P:
Univ Amsterdam, Acad Med Ctr, Amsterdam Inst Global Hlth & Dev, Dept Infect Dis, NL-1105 AZ Amsterdam, Netherlands
Amsterdam Inst Global Hlth & Dev, Dept Global Hlth, Amsterdam, Netherlands
Domingo, P:
Hosp Santa Creu & Sant Pau, Dept Infect Dis, Barcelona, Spain
Gellermann, HJ:
Boehringer Ingelheim KG, D-6507 Ingelheim, Germany
de Rossi, L:
Boehringer Ingelheim KG, D-6507 Ingelheim, Germany
Soriano, V:
Hosp Carlos III, Dept Infect Dis, Madrid, Spain
Bronze
|