Impact of switching from human immunodeficiency virus type 1 protease inhibitors to efavirenz in successfully treated adults with lipodystrophy

被引:98
作者
Martínez, E
García-Viejo, MA
Blanco, JL
Bianchi, L
Buira, E
Conget, I
Casamitjana, R
Mallolas, J
Gatell, JM
机构
[1] Hosp Clin Barcelona, Infect Dis Unit, E-08036 Barcelona, Spain
[2] Hosp Clin Barcelona, Radiol Unit, E-08036 Barcelona, Spain
[3] Hosp Clin Barcelona, Unit Endocrinol, E-08036 Barcelona, Spain
[4] Hosp Clin Barcelona, Inst Invest Biomed August Pi & Sunyer, Unit Hormonol, E-08036 Barcelona, Spain
关键词
D O I
10.1086/317426
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
We prospectively followed 20 consecutive patients with human immunodeficiency virus type 1 (HIV-1) with viral loads of <200 RNA copies/mL. These patients had been treated with 2 nucleoside reverse transcriptase inhibitors and <greater than or equal to>1 HIV-1 protease inhibitor for greater than or equal to3 months; they developed body changes consistent with lipodystrophy and requested they be switched from protease inhibitor to efavirenz, At baseline and every 3 months, we assessed the following: body mass index, waist-to-hip ratio, regional fat thickness (assessed by sonography), fasting total and high-density lipoprotein cholesterol, triglycerides, glucose, insulin, CD4(+) cells, and viral load. At baseline, hypertriglyceridemia (greater than or equal to 200 mg/dL) was present in 17 (85%) patients, hypercholesterolemia (greater than or equal to 200 mg/dL) in 14 (70%), and impaired fasting glucose (greater than or equal to 110 mg/dL) in 8 (40%); CD4(+) T cells were 280 X 10(6) cells/L (range, 64-942 X 10(6) cells/L). HIV-1 RNA had been at <200 copies/mL for a median of 14 months (range, 3-24 months). Six months after switching to efavirenz, there was a reduction in triglyceride levels (a decrease of 31%; P = .03) and fasting insulin resistance index Ca decrease of 28%; P = .03), but total and high-density lipoprotein cholesterol and glucose did not change. Waist-to-hip ratio decreased from 0.92 to 0.87 (P = .06). Subcutaneous fat thickness did not change. CD4(+) cells remained stable (363 x 10(6) cells/L; range, 102-741 X 10(6) cells/L; P = .65). Nineteen patients (95%) had HIV-1 RNA levels that remained at <200 copies/mL. Although CD4+ response and viral suppression remained preserved after 6 months of switching from protease inhibitor to efavirenz, the benefits of this approach on the evolution of lipodystrophy were limited, and our findings do not support its routine recommendation to treat lipodystrophy.
引用
收藏
页码:1266 / 1273
页数:8
相关论文
共 35 条
[1]   HETEROGENEITY IN ADIPOSE-TISSUE METABOLISM - CAUSES, IMPLICATIONS AND MANAGEMENT OF REGIONAL ADIPOSITY [J].
ABATE, N ;
GARG, A .
PROGRESS IN LIPID RESEARCH, 1995, 34 (01) :53-70
[2]  
[Anonymous], 1992, MMWR Recomm Rep, V41, P1
[3]  
ARMELLINI F, 1991, INT J OBESITY, V15, P847
[4]   Diagnosis, prediction, and natural course of HIV-1 protease-inhibitor-associated lipodystrophy, hyperlipidaemia, and diabetes mellitus: a cohort study [J].
Carr, A ;
Samaras, K ;
Thorisdottir, A ;
Kaufmann, GR ;
Chisholm, DJ ;
Cooper, DA .
LANCET, 1999, 353 (9170) :2093-2099
[5]   A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors [J].
Carr, A ;
Samaras, K ;
Burton, S ;
Law, M ;
Freund, J ;
Chisholm, DJ ;
Cooper, DA .
AIDS, 1998, 12 (07) :F51-F58
[6]  
CARR A, 1999, 6 C RETR OPP INF CHI
[7]   Detection and evaluation of dyslipoproteinemia [J].
Cleeman, JI .
ENDOCRINOLOGY AND METABOLISM CLINICS OF NORTH AMERICA, 1998, 27 (03) :597-+
[8]   Subcutaneous adipocyte apoptosis in HIV-1 protease inhibitor-associated lipodystrophy [J].
Domingo, P ;
Matias-Guiu, X ;
Pujol, RM ;
Francia, E ;
Lagarda, E ;
Sambeat, MA ;
Vázquez, G .
AIDS, 1999, 13 (16) :2261-2267
[9]   A SIMPLE MEASURE OF INSULIN-RESISTANCE [J].
DUNCAN, MH ;
SINGH, BM ;
WISE, PH ;
CARTER, G ;
ALAGHBANDZADEH, J .
LANCET, 1995, 346 (8967) :120-121
[10]  
Engelson ES, 1999, AM J CLIN NUTR, V69, P1162