24 Weeks After Substitution of Nevirapine for Protease Inhibitors, Lipid Profile and Adiponectin Concentration Improve Significantly

In the context of HIV infection and antiretroviral therapy, study results have shown that adiponectin concentrations are related to lipodystrophy, metabolic alterations and HIV-protease inhibitor (PI) use. The replacement of PI by nevirapine (Viramune) has improved the lipid profile of patients under antiretroviral therapy.

The aim of the present study was to examine whether adiponectin concentration or insulin sensitivity level correlate with the modifications of lipid parameters after the switch of PI by nevirapine.

The evolution of metabolic parameters before and after 6 months of substitution of nevirapine for protease inhibitors was evaluated in a cohort of 55 HIV-1 infected patients. Adiponectin concentration, insulin sensitivity, lipid profile, cholesterol ester transfer protein (CETP) mass concentration and triglyceride enrichment of HDL were determined before and after the replacement of PI by nevirapine.

Results

Twenty-four weeks of treatment with nevirapine improved significantly the lipid profile with a significant reduction of apoB and triglyceride.

HDL cholesterol and apoA1 increased significantly. The triglyceride enrichment of HDL significantly decreased after the replacement of PI by nevirapine.

At baseline, and after 24 weeks of nevirapine treatment, the investigators observed significant correlations between adiponectin level and lipid parameters. Twenty-four weeks of treatment with nevirapine did not significantly change adiponectin concentrations, CETP mass and insulin sensitivity.

Conclusion

In conclusion, the authors write, “This study shows that even though a strong correlation was found between adiponectin and some metabolic parameters at baseline and after 24 weeks of treatment by nevirapine, the improvement of lipid profile observed after the replacement of PI by nevirapine was not in relation to the change of plasma adiponectin concentration.”

“The significant decrease of triglyceride enrichment of HDL after the replacement of PI by nevirapine probably leads to a decreased catabolism of HDL lipoprotein, and consequently explains the increase of plasma HDL concentration observed in this study.

Hopital Universitaire du Bocage, Dijon, France.

08/23/04