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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Nevirapine and efavirenz elicit different changes in lipid profiles in antiretroviral-therapy-naive patients infected with HIV-1
PLoS Medicine, Volume 1, No. 1, Article e19, Year 2004
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Description
Background: Patients infected with HIV-1 initiating antiretroviral therapy (ART) containing a non-nucleoside reverse transcriptase inhibitor (NNRTI) show presumably fewer atherogenic lipid changes than those initiating most ARTs containing a protease inhibitor. We analysed whether lipid changes differed between the two most commonly used NNRTIs, nevirapine (NVP) and efavirenz (EFV). Methods and Findings: Prospective analysis of lipids and lipoproteins was performed in patients enrolled in the NVP and EFV treatment groups of the 2NN study who remained on allocated treatment during 48 wk of follow-up. Patients were allocated to NVP (n = 417), or EFV (n = 289) in combination with stavudine and lamivudine. The primary endpoint was percentage change over 48 wk in high-density lipoprotein cholesterol (HDL-c), total cholesterol (TC), TC:HDL-c ratio, non-HDL-c, low-density lipoprotein cholesterol, and triglycerides. The increase of HDL-c was significantly larger for patients receiving NVP (42.5%) than for patients receiving EFV (33.7%; p = 0.036), while the increase in TC was lower (26.9% and 31.1%, respectively; p = 0.073), resulting in a decrease of the TC:HDL-c ratio for patients receiving NVP (-4.1%) and an increase for patients receiving EFV (+5.9%; p < 0.001). The increase of non-HDL-c was smaller for patients receiving NVP (24.7%) than for patients receiving EFV (33.6%; p = 0.007), as were the increases of triglycerides (20.1% and 49.0%, respectively; p < 0.001) and low-density lipoprotein cholesterol (35.0% and 40.0%, respectively; p = 0.378). These differences remained, or even increased, after adjusting for changes in HIV-1 RNA and CD4+ cell levels, indicating an effect of the drugs on lipids over and above that which may be explained by suppression of HIV-1 infection. The increases in HDL-c were of the same order of magnitude as those seen with the use of the investigational HDL-c-increasing drugs. Conclusion: NVP-containing ART shows larger increases in HDL-c and decreases in TC:HDL-c ratio than an EFV-containing regimen. Based on these findings, protease-inhibitor-sparing regimens based on non-nucleoside reverse transcriptase inhibitor, particularly those containing NVP, may be expected to result in a reduced risk of coronary heart disease. © 2004 van Leth et al.
Authors & Co-Authors
van Leth, Frank C.M.
Netherlands, Amsterdam
Universiteit Van Amsterdam
Phanuphak, Praphan
Thailand, Bangkok
Thai Red Cross Agency
Stroes, Erik S.G.
Netherlands, Amsterdam
Universiteit Van Amsterdam
Gazzard, Brian George L.
United Kingdom, London
Chelsea and Westminster Hospital
Cahn, Pedro Enrique
Argentina, Buenos Aires
Fundacion Huesped
Raffi, François
France, Nantes
Chu de Nantes
Wood, Robin Y.
South Africa, Cape Town
Sommerset Hospital
South Africa, Cape Town
University of Cape Town
Bloch, Mark Theo
Australia, Sydney
Holdsworth House Medical Practice
Katlama, Christine
France, Paris
Hôpital Universitaire Pitié Salpêtrière
Kastelein, Johannes Jacob Pieter
Netherlands, Amsterdam
Universiteit Van Amsterdam
Schechter, Mauro T.
Brazil, Ribeirao Preto
Hospital Sao Francisco
Brazil, Rio de Janeiro
Universidade Federal do Rio de Janeiro
Murphy, Robert L.
United States, Evanston
Northwestern University
Horban, Andrzéj
Poland, Warsaw
Wojewodzki Szpital Zakazny
Hall, David B.
United States, Ridgefield
Boehringer Ingelheim Pharmaceuticals, Inc.
Lange, Joep M.A.
Netherlands, Amsterdam
Universiteit Van Amsterdam
Reiss, Peter
Netherlands, Amsterdam
Universiteit Van Amsterdam
Statistics
Citations: 283
Authors: 16
Affiliations: 14
Identifiers
Doi:
10.1371/journal.pmed.0010019
ISSN:
15491277
e-ISSN:
15491676
Research Areas
Infectious Diseases
Noncommunicable Diseases
Study Design
Cohort Study