HIV
and Hepatitis.com Coverage of the 14th
Annual Conference on Retroviruses and Opportunistic Infections (14th CROI) February
25 - 28, 2007, Los Angeles, CA
Compared
to Efavirenz, Lopinavir/Ritonavir Has Less Lipoatrophy When Given with NRTI
The
association of the nucleoside analogues (NNRTI) with metabolic complications is
widely known, but the role of protease inhibitors and non nucleosides in the HIV-related
metabolic syndrome is not yet clearly defined. For example, the metabolic effects
of lopinavir (LPV; Kaletra)
- or efavirenz (EFV; Sustiva)-based
regimens +
2 nucleoside reverse transcriptase inhibitors (NRTI) have not been compared
nor has the role of an NRTI-sparing regimen in preventing lipoatrophy been tested.
ACTG 5172 was
an open-label, randomized government-sponsored trial that evaluated class-sparing
regimens for treatment-naïve patients: LPV+EFV vs LPV+2 NRTI (LPV soft-gel twice
daily) vs EFV+2 NRTI. NRTI were selected before randomization from zidovudine
(ZDV; Retrovir), stavudine (d4T
XR; Zerit), or tenofovir (TDF;
Viread) (each plus lamivudine
[3TC]; Epivir). Metabolic objectives included evaluation of changes in fat
(DEXA) and fasting lipids.
Lipoatrophy was defined as ?20% loss of limb
fat from baseline. All analyses were intent to treat without adjustment for multiple
comparisons or regimen changes.
Data
analyzed following 112 weeks of treatment were presented at the 14th
CROI in Los Angeles (February 25-28, 2007). The study results showed that
a NRTI-sparing regimen (LPV+EFV) increased lipids significantly more than EFV
or LPV+2 NRTI regimens. Triglyceride
increases were also greater in LPV compared to EFV+NRTI regimens, but cholesterol
changes were not significantly different.
Compared
to EFV, LPV had less lipoatrophy when given with NRTI. The frequency of lipoatrophy
was lowest in NRTI-sparing and TDF-containing regimens.
Reference R H Haubrich, S Riddler,
G DiRienzo, and others. Metabolic Outcomes of ACTG 5142: A Prospective, Randomized,
Phase III Trial of NRTI-, PI-, and NNRTI-sparing Regimens for Initial Treatment
of HIV-1 Infection. 14th Conference on Retroviruses and Opportunistic Infections.
Los Angeles. February 25-28, 2007. Abstract 38 (oral).
