34. Distinguishable Lipid Profiles between PI and NNRTI Therapy May Carry Different Risk of Cardiovascular Disease (CVD)

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Session 7 Oral Abstract Session
Opportunistic Infections and Complications of Antiretroviral Therapy
Session Time: Monday, 10 am - 12:30 pm
Room 6E

10:45 34.

Distinguishable Lipid Profiles between PI and NNRTI Therapy May Carry Different Risk of Cardiovascular Disease (CVD)
F. van Leth*¹, N. Friis-Møller², R. Weber, A. d’Arminio Monforte, O. Kirk, R. Thiebaut, L. Morfeldt, C. Pradier, G. Calvo, M. Law, G. Bartsch, S. De Wit, C. Sabin, J. D. Lundgren², and P. Reiss¹ for the DAD Study Group
¹ATHENA, Amsterdam, The Netherlands; and ²DAD Coordinating Ctr., Copenhagen, Denmark

Background: PI-containing ART is associated with increased plasma total cholesterol (TC) and triglycerides (TG), without much change in HDL-cholesterol (HDL-c). In contrast, a rise in HDL-c leading to a reduced TC/HDL-c ratio has been shown in NNRTI-containing ART. We analysed lipid profiles in patients on different ART at enrolment in the ‘Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study, an international study of 20,000+ HIV-infected patients.
Methods: Data were analysed from all participants and a subgroup who entered ART-naïve or on first-line PI-, NVP-, or efavirenz (EFV)-containing regimens. Median values of TC,TG, HDL-c, and TC/HDL-c were estimated in a cross-sectional analysis, and risk of dyslipidemia (TC >6.2 mmol/L, and/or TG >2.3 mmol/L, and/or HDL-c <0.9 mmol/L) assessed in a multivariate model.
Results: Of 17852 patients enrolled, 11% were ART-naïve, 10% not currently on ART, 12% on NRTI, 42% on NRTI + PI, 19% on NRTI + NNRTI, and 7% on PI + NRTI + NNRTI. The proportion of patients with elevated TC in each category was (%): 8, 10, 12, 27, 23, and 45; with elevated TG: 15, 25, 25, 40, 32, and 54; with lowered HDL-c: 23, 35, 25, 27, 19, and 24, respectively. 5007 (28.0 %) were on first-line NRTI+PI and 971 (5.4 %) on first-line NRTI + NNRTI (639 (3.6%) NVP, 329 (1.8%) EFV). Median concentrations in mmol/L for TC, TG, and HDL-c were: 5.4, 1.9, and 1.1 for NRTI +PI; 5.1 ,1.4, and 1.3 for NRTI +NNRTI; 5.1, 1.3, and 1.3 for NVP; 5.1, 1.4, and 1.4 for EFV. The TC/HDL-c ratio for ART-naïve, PI, NNRTI, NVP, and EFV was 3.9, 4.9, 3.8, 3.7, and 3.8, respectively. Adjusted OR (95% CI) for elevated TC, TG, and decreased HDL when compared to ART-naïves, was 2.10 (1.65-2.67), 2.20 (1.80-2.68), and 1.49 ( 1.15-1.92) for PI; 1.33 (0.99-1.78), 1.23 (0.96-1.58), and 0.71 ( 0.49-1.04) for NNRTI. The OR (95% CI) for increased HDL-c when comparing NNRTI with PI was 2.09 (1.51-2.88), 2.34 (1.50-3.65), and 1.77(1.13-2.75) for NNRTI, NVP, and EFV, respectively.
Conclusions: Overall, the proportion of patients with elevated TC on NRTI+PI and NRTI+NNRTI was similar, but with concurrently lowered HDL-c significantly less on NRTI+NNRTI. Patients on first-line NRTI+NNRTI were less likely to have dyslipidemia, had a lower TC/HDL-c ratio, and had a 2.09-fold chance of having an elevated (cardio-protective) HDL-c when compared to those on first-line PI containing ART. Prolonged follow-up is needed to show whether these differences will translate into a differential risk of CVD.