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Partial Improvement of Lipodystrophy after Switching from HIV-1 Protease Inhibitors (PI) to Efavirenz (EFV) P. VICIANA*, A. ALARCON, D. MARTIN, P. SERRANO, L. F. LOPEZ-CORTES, E. CORDERO, and M. J. GOMEZ-VERA.
Hosp. Univ. Virgen del Rocío, Seville, Spain Objectives: To assess viral and inmune response, and changes in fat redistribution and metabolic abnormalities, in PI recipients with lipodystrophy, after switch from PI to EFV in NNRTI-naive persons.
Patients and methods: 39 consecutive HIV-infected patients on PI therapy with sustained virological suppression (<200 copies/ml) for at least 6 months (median: 11 months), and fat redistribution, replaced PI with EFV. Nucleoside analogue therapy was unchanged. Participants were assessed at day 0 and every 3 months with measurements of body mass index (BMI), waist:hip ratio (WHR), face photography and a questionnaire of subjective body changes was complimented by the patient. Fasting cholesterol, HDL-cholesterol, LDL-cholesterol, triglyceride, glycemia, CD4+ cells and viral load were performed at baseline, 1, 2, 3, 4, 6, 9 and 12 months. For de analysis VL below limit detection (BLD)= 20 copies/ml.
Results: Fifteen women and 24 men were enrolled, and completed 6 months of follow-up. Median duration of previous PI-containing regimen was 17 months (IQR, 13-21 months). Nucleoside therapy with d4T and 3TC was present in 34 (87.1%) patients. Viral load was below 200 copies/ml in 92.3% and below 20 copies/ml in 81% of patients at day 0. At month 6 VL was BLD in 82.3%, and <200 in 91.1%. Median CD4 count arise from 475 cells/ul (IQR, 301-604 cells/ul) trough 601cells/ul (IQR, 407-895 cells/ul). Most of patients (76%) subjectively reported a partial improvement in their body shape (although never as prior status) and WHR decrease from 0.94 to 0.93 (p=ns). However, BMI did not change (21.96 versus 22.06 kg/m2) and metabolic parameters showed a slightly impairment: mean triglycerides arise from 169 mg/dl at baseline to 201 mg/dl at month 6, cholesterol 202 mg/dl to 209 mg/dl, HDL cholesterol 36 mg/dl to 50 mg/dl, LDL cholesterol 113 mg/dl to 117 mg/dl and glucose 85 mg/dl to 92 mg/dl.
Conclusions: The strategy of substitution from PI to EFV maintains virological and inmunological response, but only a slightly reduction in fat redistribution. Mild elevations in lipids may also occur during the first 6 months.
Key Words: Efavirenz, Lipodystrophy, PI-Sparing Regimen
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