Effects
of Efavirenz- and Atazanavir-based Regimens on HDL Cholesterol There
is continuing interest in the effects of antiretroviral regimens on
high-density lipoprotein (HDL) cholesterol levels in patients with risk factors
for developing coronary artery disease. Both
the non-nucleoside reverse transcriptase inhibitor (NNRTI) efavirenz
(Sustiva/Stocrin) and the protease inhibitor (PI)
atazanavir (Reyataz) are widely viewed as attractive choices for antiretroviral
therapy, as they both are potent, well tolerated, and dosed once daily. Although
the low-density lipoprotein (LDL) and total cholesterol-sparing effects of atazanavir
have been well described, changes in HDL with atazanavir use have not been consistent
across studies. In contrast, use of efavirenz is known to increase serum HDL.
Because low
HDL is a risk factor for coronary artery disease, researchers at multiple medical
centers conducted a retrospective review to evaluate the effects of efavirenz-
and atazanavir-based regimens on serum HDL levels. A
total of 145 patients receiving efavirenz- or atazanavir-based regimens with baseline
and follow-up lipid profiles were included in the analysis. Linear regression
models were used to identify factors predicting changes in HDL after adjusting
for age, sex, race, baseline HDL, CD4
cell count, CD4 cell nadir, cumulative use of d4T
(stavudine, Zerit) and antiretroviral
therapy, coinfection with
hepatitis C virus, and diabetes mellitus. Results
The 111 patients on atazanavir had a median age of 40 years, 93% were male, 44%
were African American, and the mean and median baseline HDL were 33.7 and 32 mg/dL.
The 34 patients on efavirenz had a median age of 37 years, 97% were male, 47%
were African American, and the mean and median baseline HDL were of 37.7 and 33
mg/dL.
The mean increase in HDL from baseline was 6.6 mg/dL in the efavirenz group (P
< 0.02) and 3.5 mg/dL in the atazanavir group (P < 0.001).
There was no significant difference between the changes in HDL among efavirenz
and atazanavir users using a stratified Wilcoxon test (P = 0.14).
Only baseline HDL was predictive of, and inversely correlated with, changes in
HDL among both efavirenz and atazanavir users (P < 0.0001 and P < 0.001,
respectively).
Conclusion Based
on their findings, the authors concluded, "Both atazanavir and efavirenz
use result in comparable increases in HDL; the largest increases are seen in subjects
with the lowest baseline HDL." They added that, "Given these effects,
atazanavir and efavirenz may offer an advantage in patients with known risk factors
for coronary artery disease." Henry
M Jackson Foundation, TACC and National Naval Medical Center, Division of Infectious
Diseases, Bethesda, United States, Henry M Jackson Foundation and TACC, Bethesda,
United States, Henry M Jackson Foundation and TACC, San-Diego, United States,
National Naval Medical Center, Bethesda, United States, National Institute of
Allergy and Infectious Diseases, Bethesda, United States, DAIDS, Rockledge, United
States. 08/29/06 Reference
A
Ganesan, S Mccarthy, K Furtek, and others. Comparison of the changes in high density
cholesterol (HDL) among efavirenz (EFV) and atazanavir (TAZ) users and characterization
of factors associated with this change. XVI International AIDS Conference. Toronto,
August 13-18, 2006. Abstract CDB0651.
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