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Impact of Switching from HIV-1 Protease Inhibitors (PI) to Efavirenz (EFV) in Patients with Lipodystrophy E. MARTINEZ*, J. L. BLANCO, M. A. GARCIA, E. BUIRA, L. BIANCHI, I. CONGET, R. CASAMITJANA, and J. M. GATELL.
Hosp. Clin. Univ., Barcelona, Spain Objectives: To assess the effects of switching from PI to EFV on metabolic abnormalities, fat redistribution, CD4 cells and viral load.
Methods: 20 consecutive patients treated with 2 NRTI and at least 1 PI with sustained viral suppression who developed metabolic abnormalities and body changes consistent with lipodystrophy and accepted to switch from PI to EFV. Body mass index (BMI), waist:hip ratio (WHR), regional fat thickness (echography), fasting total and HDL cholesterol, triglycerides, glucose, insulin, CD4 cells and viral load were measured at baseline and every 3 months.
Results: Median age was 40 years and 11 (55%) were males. Body changes included one or more of the following: buffalo hump (n=2), breast enlargement (n=8), abdominal obesity (n=19), and fat loss in arms (n=19), legs (n=20), buttocks (n=18), and face (n=20). Most frequent therapy at baseline was d4T+3TC+indinavir (n=11, 55%). At baseline, hypertriglyceridemia (>200 mg/dL) was present in 17 (85%), hypercholesterolemia (>200 mg/dL) in 14 (70%), and impaired fasting glucose (>110 mg/dL) in 8 (40%) patients; CD4 T cells were 280/mL (range: 64–942); and HIV-1 RNA had been <200 copies/mL a median of 14 months (range: 3–24). Six months after switching, triglycerides (DOWNARROW31%) (p=0.03) and fasting insulin resistance index (DOWNARROW28%) (p=0.03) improved, but total and HDL cholesterol and glucose did not change. WHR decreased from 0.92 to 0.87 (p=0.06). Eleven patients (55%) reported a partial improvement in body changes that was related to a significant decrease in WHR and intrabdominal fat thickness. Peripheral fat did not change. CD4 cells remained stable and viral load became detectable only in one patient (555 copies/mL). Severe adverse effects occurred in 3 patients in whom EFV was substituted by nevirapine.
Conclusions: Hypertriglyceridemia, insulin resistance and abdominal obesity may improve after 6 months of switching from PI to EFV, whereas CD4 response and viral suppression remain preserved.
Key Words: EFAVIRENZ, LIPODYSTROPHY, THERAPY
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