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Metabolic
Benefits But No Morphological Improvements 24 Months after Replacing
a Protease Inhibitor with Abacavir, Efavirenz or Nevirapine
In this recent study, researchers evaluated the 24-month metabolic
and morphological (body shape) benefits obtained from
replacing the protease inhibitor (PI) in a regimen with nevirapine
(Viramune), efavirenz
(Sustiva) or abacavir
(Ziagen).
NEFA
was a randomized study designed to compare the efficacy of nevirapine,
efavirenz or abacavir as substitutes for PI. A subset of 90 patients
[abacavir (n = 29), efavirenz (n = 32), nevirapine (n = 29)] formed
the metabolic study.
Fasting
total cholesterol (TC), high density lipoprotein cholesterol
(HDL-c) and triglycerides levels were determined.
Glucose
homeostasis parameters were also collected.
Lipodystrophy was evaluated by clinical examination and morphological measurements.
Results
·
Treatment
simplification led to overall lipid
profile improvements.
·
At
24 months, the two non-nucleoside
reverse transcriptase inhibitors produced similar lipid
benefits: HDL-c levels increased [efavirenz, 15% (P = 0.001); nevirapine,
21% (P < 0.001)] and TC to HDL-c ratios decreased [efavirenz,
14% (P < 0.001); nevirapine, 19% (P < 0.01)], an effect not
observed in the abacavir arm.
·
Non-HDL-c
levels decreased by 10% in both the abacavir (P = 0.001) and efavirenz
(P < 0.05) arms.
·
Significant
decreases in the levels of triglycerides occurred for the first
year in all treatments; however, at 24 months most of the initial
loss had been regained.
·
Patients
with baseline moderate or severe lipodystrophy obtained less-pronounced
lipid benefits.
·
Several
insulin resistance markers
showed a trend towards improvement.
·
Conversely,
no improvements in morphological
abnormalities were observed.
In
conclusion, the authors write, “Replacing PI with efavirenz, nevirapine
or abacavir improved the lipid profile, with more marked results
in non-lipodystrophic patients.”
“In
contrast, this strategy does not seem to be effective for reversing
body fat abnormalities.”
From the Nutrition Section, Infectious Disease Service, Hospital
Universitari de Bellvitge, L'Hospitalet de Llobregat Infectious
Disease Service, Hospital Universitari Vall d'Hebron, Barcelona
Infectious Disease Service, Hospital Clinic, Barcelona, Spain.
06/01/05
Reference
C
Fisac and others. Metabolic benefits 24 months after replacing
a protease inhibitor with abacavir, efavirenz or nevirapine.
AIDS 19(9): 917-925. June 10, 2005.
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