672   Switching from PI to ABC Improves Insulin Sensitivity and Fasting Lipids—12-Month Follow-Up.

R. Walli, K. Huster, J. R. Bogner, and F. D. Goebel.
Med. Poliklinik, Ludwig-Maximilians Univ., Munich, Germany.

Background:Replacing PI with NNRTI can improve HAART-associated dyslipidaemia and insulin resistance in some patients. Our aim was to assess the effect of replacing protease inhibitors (PI) with abacavir (ABC) on metabolic parameters.

Methods:Pilot study on 31 patients with HAART-associated metabolic disturbances. 16 patients were switched from PI to ABC (ABC group); 15 patients continued on PI (PI group). Fasting plasma lipids and insulin sensitivity were determined at baseline and at months 3, 6, 9 and 12. Data is available for 31 patients at baseline, month 3 and month 6 and for 19 patients (11 ABC group, 8 PI group) for month 9 and month 12.

Results:Median insulin sensitivity markedly increased in the ABC group (+25, +59, +63, +58 µmol/l/min) and decreased in the PI group (-11, -31, -7, -6 µmol/l/min) after months 3, 6, 9 and 12, respectively, as compared to baseline. Median triglycerides markedly decreased in the ABC group (-40, -60, -43, -39 mg/dl) after month 3, 6, 9 and 12, respectively, as compared to baseline. Similarly, total cholesterol decreased in the ABC group (-39, -30, -35, -50 mg/dl) after month 3, 6, 9 and 12, respectively, as compared to baseline. In contrast, there was only little change in both triglycerides (+8, +19, +4, +8 mg/dl) and cholesterol (+3, -3, -4, +8 mg/dl) in the PI group after month 3, 6, 9 and 12, respectively, as compared to baseline. The changes from baseline for all time points between the ABC and the PI group reached statistical significance (p < 0.05) for insulin sensitivity, triglycerides and total cholesterol.

Conclusions:Switching from PI to ABC is associated with an improvement of insulin sensitivity and a decrease in both total cholesterol and triglycerides in the majority of patients with PI-associated metabolic disturbances. This effect is seen as early as 3 months after switching and is sustained over 12 months.