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Influence of Thymidine Analogues and NNRTI Choice on Cholesterol Levels during Antiretroviral Therapy G. J. Moyle*, C. Baldwin, S. Mandalia, and B. G. Gazzard.
Chelsea and Westminster Hosp., London, UK Background: Limited data exist on total cholesterol changes in persons receiving NNRTI plus nucleoside analogues (NA). Available data suggest rises in total cholesterol may occur in individual receiving efavirenz.
Methods: We performed a cross-sectional review of serum cholesterol (generally non-fasting) in patients receiving NNRTI (Efavirenz (EFV) or nevirapine (NVP)) + NA therapy for >1 month. Abnormal values for cholesterol were taken as >6.5mmol/l (240mg/dl) based on intervention guidelines. Association with concomitant thymidine analogue therapy, history of PI exposure, CD4 and viral load values were examined.
Results: Data are available on 241 patients, 121 on EFV, and 120 on NVP, 198 on d4T, 43 on ZDV. Cholesterol >6.5mmol/l were observed in 25% of EFV and 12% of NVP (p=0.0001) and 18% of d4T and 21% of ZDV recipients. Patients with a prior history of PI exposure were more likely to have elevated cholesterol: 25% of 94 patients compared with 14% of 147 patients. After adjusting for gender, age, duration of NNRTI therapy and PI experience, multivariate analysis indicated a significant association with normal cholesterol values and lower CD4 cell count (Relative hazard (RH) 1.6 (95% CI 1.0-2.4) for CD4 <241 vs. >531/mm3) and efavirenz use (RH 1.9 (95% CI 1.4-2.7 vs NVP). However, this difference appeared time on therapy and viral load dependent with no differences being observed between NNRTIs in the subset of patients with VL<50 copies/ml. No significant association with NA choice and viral load was observed.
Conclusions: Intervention range cholesterol levels are commonly observed during NNRTI therapy. On mulivariate analysis, lower CD4 values are associated with lower risk of cholesterol elevation during NNRTI therapy. No specific NA appeared associated with an increased risk of cholesterol elevation.
Key Words: Lipid abnormalities, NNRTI, Nucleoside analog
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