Lipid profiles of people with human immunodeficiency virus with dyslipidemia after switching from efavirenz to dolutegravir

Abstract

Introduction: Human immunodeficiency virus (HIV) infection and the long-term use of antiretroviral therapy, especially efavirenz (EFV)-based regimens, impact lipid profiles due to insulin resistance and lead to a higher risk of metabolic diseases. Dolutegravir (DTG) is an integrase inhibitor with better lipid profiles than EFV. However, data on treatment experience in Thailand are limited. The primary outcome was lipid profile changes at 24 weeks after switching therapy. Methods: We conducted a prospective, open-label, cohort study in people with HIV aged ≥18 years who had undergone at least 6 months of EFV-based therapy, had HIV-1 ribonucleic acid levels <50 copies/mL for ≥6 months before switching, and were diagnosed with dyslipidemia or had risk factors for atherosclerosis cardiovascular disease based on modified National Cholesterol Education Program Adult Treatment Panel III guidelines. Results: Sixty-four patients were enrolled. The mean age (standard deviation [SD]) was 48.20 ± 10.46 years, and 67.19% were male. At week 24, there were decreases from baseline in mean total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. However, mean body weight and waist circumference had increased. Conclusions: DTG resulted in better lipid profiles after switching from EFV-based therapy, suggesting that this switch could benefit patients with a high risk of cardiovascular disease. However, it is essential to note that weight gain and increased waist circumference were also observed.

Impacts of ainuovirine-based and efavirenz-based antiretroviral therapies on the lipid profile of HIV/AIDS patients in southern China: a real-world study

“…Moreover, improved lipid profiles were also detected in PWH with dyslipidemia receiving DTG-based regimens ( 30–32 ). However, weight gain and increased waist circumference were also observed and the price of DTG was >500% higher than EFV in many countries due to ongoing patent restrictions, which limited the widespread application of DTG in undeveloped countries ( 33–37 ). Meanwhile, in the large SINGLE study, levels of TG increased in both DTG and EFV groups ( 30 , 32 ).…”

Oral Administration of Efavirenz Dysregulates the Tph2 Gene in Brain Serotonergic Areas and Alters Weight and Mood in Mice

“…The regulation of body weight is multidimensional; it depends on metabolic, hormonal, and molecular factors (involving, among others, lipids, glucose, leptin, ghrelin, insulin, cortisol, thyroxine, growth hormone, serotonin, and some 5-HT receptors and their ligands). Although in this study we did not measure hormonal and biochemical profiles, some studies in PLWH showed that chronic administration of EFV causes changes in the levels of lipids, glucose, and cortisol, and those changes are related to age, where aging presents a high prevalence of metabolic diseases and weight gain [ 51 , 52 , 53 , 54 ]. In studies reported by Baza Caraciolo et al, in 2007, the lipid profile of HIV-positive patients without treatment was evaluated, where a marked decrease in HDL, ApoA1, and total cholesterol were significantly lower in HIV (+) patients independent of CD4 levels, finding significantly higher atherogenic risk regardless of the presence of other risk factors [ 55 ].…”

Evaluation of Lipid Profile and Intima Media Thickness in Antiretroviral-Experienced HIV-Infected Patients Treated with Protease Inhibitor-Based Regimens versus Protease Inhibitor-Sparing Regimens

“…This is the reason why more metabolic-friendly treatment regimens have been developed in recent years. The advent of INIs has allowed the adoption of two-drug regimens, with similar efficacy and a better tolerability profile than triple regimens [ 25 , 26 , 27 , 28 , 29 ].…”