Management of dyslipidemia in HIV-infected patients

Malvestutto, Carlos; Aberg, Judith A.

doi:10.2217/clp.11.25

Cited by 31 publications

(15 citation statements)

References 108 publications

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“…Among the ritonavir-boosted protease inhibitors, ATV/r has low lipogenicity, as evidenced by fewer lipid increases than lopinavir/r and only small lipid elevations reported in direct comparisons in treatment-naive subjects 14,42 and in treatment-experienced subjects switched from lopinavir/r to ATV/r. 43,44 Unboosted ATV, relative to most other protease inhibitors, has been documented to have little effect on lipids, 45 which is consistent with what we observed. The median 15-mg/dl increase in HDL-cholesterol seen in both the unboosted ATV and ATV/r groups allowed the total cholesterol/HDL-cholesterol ratio to improve slightly.…”

Section: Discussionsupporting

confidence: 90%

Inflammatory Biomarker Changes and Their Correlation with Framingham Cardiovascular Risk and Lipid Changes in Antiretroviral-Naive HIV-Infected Patients Treated for 144 Weeks with Abacavir/Lamivudine/Atazanavir with or without Ritonavir in ARIES

Young¹,

Squires

Ross

et al. 2013

AIDS Research and Human Retroviruses

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Propensity for developing coronary heart disease (CHD) is linked with Framingham-defined cardiovascular risk factors and elevated inflammatory biomarkers. Cardiovascular risk and inflammatory biomarkers were evaluated in ARIES, a Phase IIIb/IV clinical trial in which 515 antiretroviral-naive HIV-infected subjects initially received abacavir/lamivudine + atazanavir/ritonavir for 36 weeks. Subjects who were virologically suppressed by week 30 were randomized 1:1 at week 36 to either maintain or discontinue ritonavir for an additional 108 weeks. Framingham 10-year CHD risk scores (FRS) and risk category of <6% or ≥6%, lipoprotein-associated phospholipase A(2) (Lp-PLA(2)), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hsCRP) were assessed at baseline, week 84, and week 144. Biomarkers were stratified by FRS category. When ritonavir-boosted/nonboosted treatment groups were combined, median hsCRP did not change significantly between baseline (1.6 mg/liter) and week 144 (1.4 mg/liter) in subjects with FRS <6% (p=0.535) or with FRS ≥6% (1.9 mg/liter vs. 2.0 mg/liter, respectively; p=0.102). Median IL-6 was similar for subjects with FRS <6% (p=0.267) at baseline (1.6 pg/ml) and week 144 (1.4 pg/ml) and for FRS ≥6% (2.0 pg/ml vs. 2.2 pg/ml, respectively; p=0.099). Median Lp-PLA(2) decreased significantly (p<0.001) between baseline (197 nmol/min/ml) and week 144 (168 nmol/min/ml) in subjects with FRS <6% and with FRS ≥6% (238 nmol/min/ml vs. 175 nmol/min/ml, respectively; p<0.001). In conclusion, in antiretroviral-naive subjects treated with abacavir-based therapy for 144 weeks, median inflammatory biomarker levels for hsCRP and IL-6 generally remained stable with no significant difference between baseline and week 144 for subjects with either FRS <6% or FRS ≥6%. Lp-PLA(2) median values declined significantly over 144 weeks for subjects in either FRS stratum.

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Section: Discussionsupporting

confidence: 90%

Inflammatory Biomarker Changes and Their Correlation with Framingham Cardiovascular Risk and Lipid Changes in Antiretroviral-Naive HIV-Infected Patients Treated for 144 Weeks with Abacavir/Lamivudine/Atazanavir with or without Ritonavir in ARIES

Young¹,

Squires

Ross

et al. 2013

AIDS Research and Human Retroviruses

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“…Consequently, the current study was aimed to evaluate the influence of cART on metabolic parameters and estimated cardiovascular risk dependently on the PI used in the therapy. In clinical studies, atazanavir has been shown to provoke dyslipidaemia rarely than comparators [22]. Although it should be remembered, that this effect could be diminished when ATV is accompanied by ritonavir (RTV, r) [23].…”

Section: Discussionmentioning

confidence: 99%

Metabolic abnormalities and cardiovascular risk in HIV-infected cohort of patients treated with protease inhibitors

et al. 2015

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a b s t r a c tAim: Aim of this study was to evaluate cardiovascular risk in HIV-infected patients treated with atazanavir or lopinavir, both boosted with ritonavir, in Poland. Background: Introduction into clinical practice of cART has succeeded in decline in AIDS-related mortality and extended the life expectancy of patients living with HIV/AIDS. Observed, anyhow, side effects such as dyslipidemia and, as a result, cardiovascular disease seems to become predominant cause of mortality in this population. Materials and methods: The study was a retrospective data analysis of HIV infected patients on ATV/r or LPV/r, treated between 1st of November 2004 and 31st of March 2009, and continued this treatment for at least 24 weeks. Results: The study population included 328 patients (82 women and 246 men) within age range between 23 and 75 years (mean 38.5 ± 9.2 years) divided into two groups: group A (148 patients on atazanavir 300 mg + ritonavir 100 mg/d) and group B (180 patients treated with lopinavir/ritonavir 800/200 mg/d).Changes in the level of cholesterol, triglycerides and glucose were significantly different in the treatment groups (p-value: 0.01, 0.009, 0.02 respectively). SCORE scale increase during observation did not differ statistically (p = 0.53). Increase in cholesterol and triglyceride levels was higher in the group B (17.0% vs 7.8% and 41.5% vs 16.8%) while the increase in the level of glucose was in the group A (5.2% vs 0.7%). Conclusion: The study confirms differences in CV risk factors between different cART drugs and this should be considered during initiation of the therapy.

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“…23,30 The magnitude of these changes is also reflective of ethnicity, race, sex, lifestyle factors, and genomic traits. 31 As noted earlier, the PI and the NNRTI are the ART that most significantly influence lipid levels. Tables 1 and 2 provide detail on the changes that are seen with use of medications in each of these classes of ART.…”

Section: Antiretroviral Therapymentioning

confidence: 84%

“…74 Drug-drug interactions between antiretroviral therapy and statins Table 4 provides a summary of the interactions between ART and statin drugs. 31,75 Lovastatin and simvastatin are contraindicated with PI because they have extensive first-pass metabolism by cytochrome P450 3A isoenzymes (CYP3A4) in the liver. Atorvastatin undergoes less first-pass metabolism by CYP3A4, and doses up to 40 mg daily can be used with PI.…”

Section: Medications Statinsmentioning

confidence: 99%

Lipid Management in Human Immunodeficiency Virus

Myerson¹

2015

Cardiology Clinics

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Management of dyslipidemia in HIV-infected patients

Cited by 31 publications

References 108 publications

Inflammatory Biomarker Changes and Their Correlation with Framingham Cardiovascular Risk and Lipid Changes in Antiretroviral-Naive HIV-Infected Patients Treated for 144 Weeks with Abacavir/Lamivudine/Atazanavir with or without Ritonavir in ARIES

Inflammatory Biomarker Changes and Their Correlation with Framingham Cardiovascular Risk and Lipid Changes in Antiretroviral-Naive HIV-Infected Patients Treated for 144 Weeks with Abacavir/Lamivudine/Atazanavir with or without Ritonavir in ARIES

Metabolic abnormalities and cardiovascular risk in HIV-infected cohort of patients treated with protease inhibitors

Lipid Management in Human Immunodeficiency Virus

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