Lopinavir/ritonavir Combination and Total/HDL Cholesterol Ratio

The aim of the current study was to describe the lipid profile among lopinavir/ritinavir (Kaletra) patients in a “real life” situation.

Lipids measurements at LPV/r initiation time and every 3 months, and pharmacological measurements at M3 and M6 were collected retrospectively in 142 patients attending a French clinic.

Dyslipidaemia was defined as total cholesterol >/=6.2 mmol/l, HDL-cholesterol >/=1 mmol/l, total/HDL-cholesterol ratio >/=6.5 and triglycerides >/=2.3 mmol/l.

Results

· Eighty-nine percent of patients had previously received a regimen with protease inhibitors, 4% were treatment naive. At baseline, 17% of patients had high total cholesterol, 49% high triglycerides, 63% low HDL-cholesterol, 25% a high total/HDL-cholesterol ratio.

· At M12, the mean HDL-cholesterol increase per patient was 21%.

· Lipids levels significantly increased over the study period, as early as the 3rd month (6th month for ratio) and continuously until the 12th month.

· Among the patients with available LPV/r plasma determinations at M3, a higher lopinavir residual concentration was observed in those with high triglycerides as, at M6, in those with an elevated ratio.

Conclusions

The authors conclude, “These results suggest that LPV/r may induce a significant rise in the total/HDL-cholesterol ratio, despite an increase in HDL-cholesterol levels. The association between triglycerides and total/HDL-cholesterol ratio elevated levels and high residual concentrations of lopinavir may also argue for systematic [therapeutic] drug monitoring.”

Department of Public Health, Hopital de l'Archet I, Centre Hospitalier Universitaire, Route de Saint Antoine de Ginestiere, France.

04/04/05

Reference
L Valerio and others. Lopinavir/ritonavir combination and total/HDL cholesterol ratio. Journal of Infection 50(3): 229-235. April 2005.

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