Lipids, NRTIs and NNRTIs

Elevated lipids (both cholesterol and triglycerides) may occur among people on protease-sparing regimens. A study conducted at the Chelsea and Westminster Hospital in London, for example, found high triglycerides among 2-6% of people taking PI-sparing regimens, and high cholesterol levels among 40%. 1

Certain NRTIs appear to affect lipid levels. d4T has been associated with significantly greater rises in cholesterol and triglycerides than tenofovir after 48 weeks, requiring more people on d4T to start lipid-lowering therapy. 2 3

Studies suggest that lipid levels may fall slightly or remain static after switching from a PI to an NNRTI. 4 5 Nevirapine has been found not to worsen metabolic abnormalities, although it did not improve pre-existing problems. 6

There is evidence that low HDL levels are a result of HIV infection itself, rather than antiretroviral therapy. 7 However, HDL cholesterol levels have been seen to improve with nevirapine and with efavirenz. 8 9 10 In one large comparison, nevirapine resulted in greater increases in HDL cholesterol and greater triglyceride reduction than efavirenz.10

 

References

  1. Matthews GV et al. Absence of association between individual thymidine analogues or nonnucleoside analogues and lipid abnormalities in HIV-1-infected persons on initial therapy. Journal of Acquired Immune Deficiency Syndromes 24(4): 310-315, 2000
  2. Staszewski S et al. Efficacy and safety of tenofovir disoproxil fumarate versus stavudine (d4T) when used in combination with lamivudine (3TC) and efavirenz in HIV-1 infected patients naïve to antiretroviral therapy: 48 week results. Fourteenth International AIDS Conference, Barcelona, abstract LbOr17, 2002
  3. Staszewski S et al. Efficacy and safety of tenofovir DF (TDF) versus stavudine (d4T) when used in combination with lamivudine and efavirenz in antiretroviral naïve patients: 96-week preliminary interim results. Tenth Conference on Retroviruses and Opportunistic Infections, Boston, abstract 564b, 2003
  4. van der Valk M et al. Nevirapine containing potent antiretroviral therapy results in an anti-atherogenic plasma lipid profile: results from the Atlantic Trial. Eighth Conference on Retroviruses and Opportunistic Infections, Chicago, abstract 654b, 2001
  5. Martinez E et al. Impact of switching from human immunodeficiency virus type 1 protease inhibitors to efavirenz in successfully treated adults with lipodystrophy. Clinical Infectious Diseases 31(5):1266-1273, 2000
  6. Bentata-Pessayre M et al. Metabolic and morphologic tolerance of nevirapine in naive or pre-treated HIV1 infected patients. 13th International AIDS Conference, Durban, abstract B4202, 2000
  7. Kingsley L et al. Prevalence of lipodystrophy and metabolic abnormalities in the Multicenter AIDS Cohort Study (MACS). Eighth Conference on Retroviruses and Opportunistic Infections, Chicago, abstract 538, 2001
  8. van der Valk M et al. Increased risk of lipodystrophy when nucleoside analogue reverse transcriptase inhibitors are included with protease inhibitors in the treatment of HIV-1 infection. AIDS 15: 847-855, 2001a
  9. van der Valk M et al. Nevirapine-containing antiretroviral therapy in HIV-1 infected patients results in an anti-atherogenic lipid profile. AIDS 15: 2407-2414, 2001c
  10. Van Leth F et al. Nevirapine and efavirenz elicit different changes in lipid profiles in antiretroviral-therapy-naïve patients infected with HIV-1. PLOS Med 1: e19, 2004
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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