Background
A strong inverse relationship between the plasma concentration of HDL-C and the incidence of coronary heart disease is widely accepted. Few interventions have succeeded to increase plasma HDL levels in HIV-infected pts. NVP has a favorable lipid profile, and clinical trials have suggested that it could have a differential effect on plasma HDL-C levels.
Methods
Prospective, single arm, multicenter study. We included patients on stable antiretroviral therapy with HIV RNA ≤50 copies/mL for at least one year that were switched to a NVP-containing regimen. Patients receiving lipid lowering therapy were excluded. HDL-cholesterol and other lipid parameters at baseline and after 24 weeks of treatment with NVP are compared.
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Results
Among 130 pts included in the study, 119 (91%) could be evaluated. BL characteristics: median age 44, female 24%, current smokers 53%. Previous AIDS 29%, CD4 count 502/mm3. Time on ARV therapy 42 months. Previous therapy: efavirenz 38%, 3 NRTI 12%, PI 50%. Accompanying nucleosides were tenofovir/emtricitabine in 69%, and abacavir/lamivudine in 31%.
Table 1 shows the 24-week results of lipid profile.
Table 1
Mean | S. D. | N | p | ||
|---|---|---|---|---|---|
Triglycerides (mg/dl) | Previous treatment | 213.8 | 178.3 | 119 | |
Nevirapine | 154.6 | 95.3 | 119 | <0.05 | |
TC (mg/dl) | Previous treatment | 203.6 | 48.0 | 119 | |
Nevirapine | 198.1 | 40.5 | 119 | 0.108 | |
HDL-C (mg/dl) | Previous treatment | 43.8 | 14.6 | 119 | |
Nevirapine | 49.3 | 16.8 | 119 | <0.05 | |
TC/HDL-C | Previous treatment | 5.1 | 1.9 | 119 | |
Nevirapine | 4.3 | 1.3 | 119 | <0.05 | |
LDL (mg/dl) | Previous treatment | 120.2 | 38.1 | 107 | |
Nevirapine | 119.2 | 32.7 | 107 | 0.705 | |
VLDL (mg/dl) | Previous treatment | 35.1 | 19.4 | 25 | |
Nevirapine | 23.6 | 12.6 | 25 | <0.05 |
At 24 week, the proportion of patients with HDL-C>40 mg/dl were 69.7% (95%CI 60.7-77.8), compared to 52.1% (95%CI 42.8-61.3) before taking NVP (p<0.01). The Framingham risk score decreased from 7.6 to 6.6 (p<0.05) after switching to NVP.
Conclusions
Switching to NVP-containing regimens in patients on stable therapy is associated with a significant increase in HDL-C and decrease in TC/HDL-c, with an overall improvement in the Framingham score.
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This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.