Abstract 654B - Nevirapine Containing Potent Antiretroviral Therapy Results in Ananti- Atherogenic Plasma Lipid Profile: Results from the Atlantic Trial.

654B Nevirapine Containing Potent Antiretroviral Therapy Results in Ananti- Atherogenic Plasma Lipid Profile: Results from the Atlantic Trial.

M. Van Der Valk*^1,2, P. Reiss^1,2, H. Molhuizen¹, R. Stellato¹, C. Katlama³, A. Horban⁴, M. Glesby⁵, G. Behrens⁶, B. Clotet⁷, J. Kastelein¹, and R. Murphy⁷on behalf of the Atlantic investigators.
¹Academic Med. Ctr. &²2IATEC, Amsterdam, The Netherlands;³Hosp. Pitié-Salpetriere, Paris, France;⁴Hosp. Wojewodzki Zakazny, Warsaw, Poland;⁵Cornell Univ., New York, NY;⁶MHH, Hannover, Germany;⁷Hosp. Univ., Badalona, Spain; and⁸NorthwesternUniv., Chicago, IL.

Background:Most protease inhibitor-(PI) containing antiretroviral therapy is associated with elevated triglyceride and LDL-cholesterol (LDL-c) levels which may expose patients (pts) to an increased risk of coronary artery disease (CAD).

Methods:We determined lipoprotein profiles in prospectively collected (fasting not mandated) plasma samples at baseline and 24 weeks of treatment from a representative subset of naïve pts enrolled in the Atlantic trial. Pts were randomly assigned to treatment with d4T+ddI plus either nevirapine (NVP), indinavir (IDV), or 3TC. Levels of VLDL, LDL and HDL subclasses as well as particle size were quantified by NMR spectroscopy. LpAI and ApoAI levels were also assessed.

Results:A profile including a striking 33% increase in HDL-c, a decrease in the total cholesterol/ HDL-C ratio, an increase in HDL size, as well as in Apo AI and Lp AI levels, was observed in pts on NVP at 24 weeks (n=31) (see table), but not in pts on IDV or 3TC.

NVP-arm Mean (±SD)
Parameter	week 0	week 24	p
HDL-c, mg/dl	37.9 ± 9.4	50.4 ± 16.9	<0.0001
TC:HDL-C	4.79 ± 0.27	4.27 ± 0.18	< 0.01
LDL-c, mg/dl	111.1 ± 33.0	120.9 ± 34.9	0.0261
Large HDL-c, mg/dl	25.9 ± 11.3	37.4 ± 17.9	<0.0001
HDL particle size,nm	8.9 ± 0.4	9.2 ± 0.6	0.0009
Apo AI, mg/l	1107 ± 173	1274 ± 223	<0.0001
Lp AI , g/l	0.37 ± 0.08	0.47 ± 0.14	<0.0001

Conclusions:A regimen of d4T/ddI plus NVP, but not IDV or 3TC, resulted in a lipid profile which is associated with a sharp reduction in CAD risk in other settings.