Lipoprotein changes in HIV-infected antiretroviral-naïve individuals after starting antiretroviral therapy: ACTG Study A5152s

James H. Stein*, Lauren Komarow, Bruno R. Cotter, Judith S. Currier, Michael P. Dubé, Carl J. Fichtenbaum, Mariana Gerschenson, Carol K.C. Mitchell, Robert L. Murphy, Kathleen Squires, Robert A. Parker, Francesca J. Torriani

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

27 Scopus citations

Abstract

Background: Dyslipidemia is a frequent complication of antiretroviral therapy (ART) for patients with human immunodeficiency virus infection (HIV). The effects of ART on lipoproteins are less well-understood, and have not been investigated in a prospective study where assignment to ART is randomized. Objective: To evaluate the effects of three class-sparing ART regimens on lipids and lipoproteins. Methods: This was a substudy of a prospective, multicenter study of treatment-naïve HIV-infected individuals randomly assigned to receive a regimen of nucleoside reverse transcriptase inhibitors (NRTIs) + the non-nucleoside reverse transcriptase inhibitor efavirenz, NRTIs + the protease inhibitor lopinavir/ritonavir, or a NRTI-sparing regimen of efavirenz + lopinavir/ritonavir. Lipoproteins were measured by nuclear magnetic resonance spectroscopy. Results: Among the 82 participants, total and small low-density lipoprotein concentrations increased by a median of 152 nmol/L (interquartile range, -49 to +407 nmol/L; P < 0.01) and 130 nmol/L (interquartile range, -98 to +417 nmol/L; P < 0.01), respectively, especially in the arms containing lopinavir/ritonavir (PKW < 0.04). Very-low-density lipoproteins also increased (P < 0.01), with a larger increase in the arms that contained lopinavir/ritonavir (P = 0.022). High-density lipoproteins increased by a median of 6.0 nmol/L (interquartile range, 2.8-10.4 nmol/L; P < 0.01), but differences between arms were not significant (PKW = 0.069). Changes were not related to changes in markers of insulin/glucose metabolism. Conclusions: Total and small low-density lipoprotein concentrations increased, especially in the arms containing lopinavir/ritonavir, as did increases in total very-low-density lipoproteins. Adverse changes were especially prominent in the arm with efavirenz + lopinavir/ritonavir.

Original languageEnglish (US)
Pages (from-to)464-471
Number of pages8
JournalJournal of Clinical Lipidology
Volume2
Issue number6
DOIs
StatePublished - Dec 2008

Funding

This multicenter trial was conducted by the AIDS Clinical Trials Group and was funded by the National Institute of Allergy and Infectious Diseases and the National Heart, Lung, and Blood Institute. Pharmaceutical support was provided by Abbott Laboratories and Bristol-Myers Squibb Company. Neither pharmaceutical company was involved in the design, conduct, or analysis of data from this study, or in the writing of this article. Other support included: National Institutes of Health (NIH) AI069424, AI56933, and AI069428 to J. Currier; NIH AI25859, HL72711, RR00750, and RR000750 to M. Dubé; NIH AI069513 to C. Fichtenbaum; NIH AI34853, RR16467, and MD000173 to M. Gerschenson; NIH AI069471 to R Murphy; NIH AI38855 and AI068634 to L. Komarow; NIH AI38855 and AI068634 to R. Parker; NIH RR16176 and AI25915 to J. H. Stein; NIH AI69432 to F. J. Torriani; and NIH AI38558 and NIH AI068636 to ACTG leadership.

Keywords

  • Antiretroviral therapy
  • Cardiovascular risk
  • Clinical trial
  • Human immunodeficiency virus
  • Lipids
  • Lipoproteins

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics
  • Cardiology and Cardiovascular Medicine

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