Body Fat and Other Metabolic Effects of Atazanavir and Efavirenz, Each Administered in Combination with Zidovudine plus Lamivudine, in Antiretroviral- Naive HIV-Infected Patients

Jemsek, Joseph G.; Arathoon, Eduardo; Arlotti, Massimo; Pérez, Carlos Enrique Tene; Sosa, Néstor; Pokrovskiy, Vadim; Thiry, Alexandra; Soccodato, Michael; Noor, Mustafa A.; Giordano, Michael

doi:10.1086/498505

Cited by 102 publications

(77 citation statements)

References 28 publications

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“…Thus, the therapeutic regimen made up by the combination of Zidovudine + Lamivudine + Efavirenz (AZT + 3TC + EFZ) was shown to be a protector against LS (p=0.0149). A study carried out with 100 patients who received this same therapeutic combination for 48 weeks and who were later evaluated using imaging exams -computerized tomography and DEXA -dual X-ray absorptiometry -confirms that this therapeutic regimen is not associated with significant morphological changes, as it resulted in a minimal and modest fat accumulation (19) .…”

Section: Discussionmentioning

confidence: 88%

Body changes: antiretroviral therapy and lipodystrophy syndrome in people living with HIV/aids

Tsuda¹,

Silva²,

Machado

et al. 2012

Rev. Latino-Am. Enfermagem

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Objective: to identify the different types of morphological alterations from lipodystrophy syndrome (LS) in outpatients and relate them to the therapeutic regimen used. Method: a cross-sectional study which recruited 60 patients with HIV and LS and 79 without LS, who consented to interview and data collection from their medical notes. Results: the region most affected by lipoatrophy was the face; by lipohypertrophy, the abdomen, and by the Alteraciones corporales: terapia antirretroviral y síndrome de la lipodistrofia en personas que viven con VIH/SIDA Objetivo: identificar los diferentes tipos de alteraciones morfológicas del Síndrome de la lipodistrofia (SL) en pacientes de los servicios de ambulatorio y relacionarlas al esquema terapéutico utilizado. Método: estudio transversal en lo que fueron reclutados 60 pacientes con VIH y la SL y 79 sin la SL, que consintieron entrevista y recogida de datos en prontuario. Resultados: la región más acometida por la lipoatrofia fue la cara; por la lipohipertrofia el Abdomen y por la forma mixta las alteraciones en Abdomen, cara, miembros superiores e inferiores. Conclusión: entre los esquemas terapéuticos, el compuesto por la zidovudina, lamivudina y efavirenz pareció proteger contra la SL.La enfermería puede actuar en la identificación precoz de las alteraciones, además de suministrar orientaciones y apoyo a los pacientes acometidos por los cambios en la imagen corporal.

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Section: Discussionmentioning

confidence: 88%

Body changes: antiretroviral therapy and lipodystrophy syndrome in people living with HIV/aids

Tsuda¹,

Silva²,

Machado

et al. 2012

Rev. Latino-Am. Enfermagem

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“…The International AIDS Society-USA (IAS-USA) Panel describes a list of mutations in the protease gene that are associated with resistance to ATV. This list include changes at positions 10,16,20,24,32,33,34,36,46,48,50,53,54,60,62,64,71,73,82,84,85,88,90 and 93, although the only changes considered as major mutations are I50L, I84V and N88S.…”

Section: Drug Resistancementioning

confidence: 99%

“…Based on data at week 48 from a substudy of the AI424-034 trial, 5 it would appear that ATV has little effect on changes in fat redistribution. 71 This substudy focused on subjects with CD4 counts Ͼ100 cells/μL, whose initial antiretroviral therapy consisted of ZDV + 3TC plus either EFV or ATV. There was no evidence of lipoatrophy at 48 weeks in any treatment arm; although there was a small increase in both abdominal subcutaneous and limb fat levels, which was not statistically signifi cant.…”

Section: Atazanavir In Switch Studiesmentioning

confidence: 99%

Role of atazanavir in the treatment of HIV infection

Soriano¹

2008

TCRM

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Atazanavir (ATV) is one of the latest protease inhibitors (PI) approved for the treatment of HIV infection. The drug has a relatively long-life (∼7 h) and large inhibitory quotient which allows once daily administration. It is generally well tolerated and the main side effect is hyperbilirubinemia, since ATV inhibits the hepatic uridin-glucoronyl-transferase. A signature mutation at the protease gene, I50L, may confer loss of susceptibility to the drug. Interestingly, it produces hypersusceptibility to all other PIs. When ATV is pharmacokinetically boosted with ritonavir (r) 100 mg/day, a greater genetic barrier for resistance is achieved, and generally more than 3 major PI resistance associated mutations are needed to result in ATV resistance. In drugnaïve subjects, regimens based on ATV/r have shown non-inferiority compared to lopinavir (LPV)/r (CASTLE study) or fosamprenavir/r (ALERT trial), generally with improved tolerance (less diarrhea and dyslipidemia). Given its good tolerance and convenience, ATV has been proven to be successful as a simplifi cation strategy in switch studies (ie, SWAN and SLOAT) conducted in patients with complete virological suppression under other PI-based regimens. Finally, ATV/r-based combinations have shown to be equivalent in terms of viral response to other PI/r-containing regimens, including LPV/r, in rescue interventions in patients failing other PI regimens (ie, studies AI424-045 and NADIS).

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“…Dyslipidemia in HIV-infected patients using HAART includes, elevated level of total cholesterol (TC), LDL cholesterol (LDL-c), triglycerides (TG), and decreased HDLcholesterol (HDL-c), and severe hypertriglyceridemia in several patients (El-Sadr et al, 2005). Stavudine (d4T) from nucleoside reverse transcriptase inhibitors (NRTIs) regimens is the most commonly mentioned antiretroviral agent that is being associated with metabolic syndrome (MS) and HIV related fat accumulation (Matinez et al, 2004;Jemsek et al, 2006). Lipoatrophy and lipohypertrophy are associated with multiple metabolic derangements in the setting of HIV infection and antiretroviral therapy (ART).…”

Section: Introductionmentioning

confidence: 99%

Change in serum lipid profiles and glucose after switching from stavudine/lamivudine to zidovudine/lamivudine in non-nucleoside reverse transcriptase inhibitors based anti-retroviral regimens in Southern Ethiopia

Tadewos¹,

Fenta²

2015

J. AIDS HIV Res.

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Data concerning any difference in serum lipid profiles and glucose level after patients switched from stavudine to zidovudine in Ethiopia is very limited. Seventy eight adults receiving antiretroviral therapy (ART) that included stavudine/lamivudine with either of efavirenz or nevirapine during ART initiation were enrolled. Of these patients, 53 were switched to zidovudine/lamivudine/nevirapine (NVP-group) and the rest 25 were switched to zidovudine/lamivudine/efavirenz (EFV-group). Serum lipid profiles and glucose were determined after overnight fasting. Dyslipidemia and dysglycaemia were assessed according to the United State National Cholesterol Education program-III guideline. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) Version 20. Of the 78 patients, 39.7% were males and 60.3% were females. At the end of the study follow-up, the prevalence of TC ≥ 200 mg/dl, LDL-c ≥ 130 mg/dl, TG ≥ 150 mg/dl, HDL-c < 40 mg/dl and glucose ≥ 110 mg/dl were higher in EFV group when compared with NVP. About 74.4% patients had at least two laboratory abnormities which is compatible with a diagnosis of dyslipidemia at 12 month of post switch. Four lipid profiles abnormal within a single individual was 16% in EFV and 3.8% in NVP group, p = 0.08. Raised HDL-c concentration was observed in NVP group in both periods when compared with EFV. In addition, patients that switched from d4T/3TC/NVP to AZT/3TC/NVP had a significant change in TC and TG (p = 0.001 for both). Also TC ≥ 200 mg/dl was decreased from 49 to 16% (p = 0.04). Furthermore, sex was significantly and negatively associated with raised TC and TGs among patients using NVP based regimen. Raised HDL-c concentration, decreased proportion of abnormal lipid profiles and abnormal glucose was observed in the NVP group. Based on these findings, NVP may be expected to reduce the risk of cardiovascular diseases.

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Body Fat and Other Metabolic Effects of Atazanavir and Efavirenz, Each Administered in Combination with Zidovudine plus Lamivudine, in Antiretroviral- Naive HIV-Infected Patients

Cited by 102 publications

References 28 publications

Body changes: antiretroviral therapy and lipodystrophy syndrome in people living with HIV/aids

Body changes: antiretroviral therapy and lipodystrophy syndrome in people living with HIV/aids

Role of atazanavir in the treatment of HIV infection

Change in serum lipid profiles and glucose after switching from stavudine/lamivudine to zidovudine/lamivudine in non-nucleoside reverse transcriptase inhibitors based anti-retroviral regimens in Southern Ethiopia

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