The Lipid-Lowering Efficacy of Switching Within Non-Nucleoside Reverse Transcriptase Inhibitors in HIV-Infected Patients
A.M. Bain, K.D. Payne, A.P. Rahman, R. Bedimo, D.O. Maclayton, M. Rodriguez-Barradas and A.J. Busti
DOI : 10.3844/ajidsp.2008.147.151
American Journal of Infectious Diseases
Volume 4, Issue 2
The objective of present research is to evaluate the lipid lowering efficacy and safety of switching within non-nucleoside reverse transcriptase inhibitors (NNRTI) in HIV-infected patients. This is a multicenter, retrospective study utilizing a comprehensive electronic patient registry to identify all adult HIV-infected patients seen from October 1, 1998 through October 1, 2006, who substituted efavirenz for nevirapine (EFV→NVP) or vice-versa (NVP→EFV), without change in other antiretrovirals. Lipid profiles before and after the switch were analyzed. A total of 124 patients were identified with 14 male (EFV→NVP, n = 9; NVP→EFV, n = 5) patients meeting the strict criteria for inclusion. An EFV→NVP switch resulted in significant reductions in TC -16% and non-HDL -25% (p≤0.02) and a trend towards a reduction in LDL-C -12%, TG -27%, TC/HDL -23%, TG/HDL -48% and an increase in HDL-C +15% without any changes to BMI, viral or immunological control. However, a NVP→EFV switch appeared to result in a non-significant worsening of LDL-C +29%, HDL-C -8%, TG +36%, non-HDL +28%, TC/HDL +57% and TG/HDL +46%. Lastly, more patients achieved their lipid goals when switched from EFV to NVP. These data suggest that switching from EFV to NVP-based HAART is associated with lipid improvement, however, switching from NVP to EFV-based HAART is associated with worsening of serum lipids.
© 2008 A.M. Bain, K.D. Payne, A.P. Rahman, R. Bedimo, D.O. Maclayton, M. Rodriguez-Barradas and A.J. Busti. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.