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Session 100
Poster Abstracts Dyslipidemias and Body Fat Abnormalities: Incidence, Risk Factors, Response to Therapy Monday, 1:30 - 3:30 pm Poster Hall |
Background: Lopinavir (LPV)/ritonavir (r)-including
regimens are associated with hyperlipidemia, but predictive factors related to
this adverse event are still unclear.
Methods: We conducted an observational study of
HIV-patients starting LPV/r after failing HAART, with follow-up at ≥3
months. Triglycerides, total cholesterol, HIV-RNA, CD4+, and any
clinical events were recorded every 3 months. End-points were
hypertriglyceridemia (triglycerides ≥180 mg/dL for patients with
triglycerides <180 mg/dL at baseline‑LPV/r initiation‑or an increase
of ≥30% for others) and hypercholesterolemia (cholesterol >190
mg/dL for patients with cholesterol <190 mg/dL at baseline or an increase of
≥30% for others). T-tests were used to compare mean changes between
groups; the Kaplan-Meyer model to estimate time-dependent probability of
reaching end-points; and the multivariable Cox model was used to identify
predictive factors of hypertriglyceridemia and hypercholerolemia. Variables
included in the analysis were: demographics, CD4+, HIV-RNA,
triglycerides, cholesterol, and glucose at baseline, total time on ARV, number
of PI, NRTI, and NNRTI changed, and drugs in previous and current HAART. Data
were analyzed according to an intention to treat approach.
Results: A total of 416
patients were included (70.9% men, median age 38 years). LPV/r was associated
with 2 NRTI in most patients (AZT/3TC in 26.4%). In a median follow-up of 423
days (range 102 to 928), 308 patients (73.2%) developed hypertriglyceridemia
and 206 (48.9%) hypercholerolemia; the Kaplan-Meyer probability was 56.2% (53.8
to 58.7) and 37.6% (35.2 to 40.0) at month 3, and 71.6% (69.4 to 73.9) and
48.0% (45.5 to 50.5) at month 12, respectively. The only predictive factor of
hypertrig was a grade 1 hypertriglyceridemia (180 to 400 mg/dL) at baseline
(RR: 3.3, 95% CI: 1.0 to 10.6, p = 0.04 vs triglycerides <180 mg/dL). Predictive factors of
hyperchol were: grade 1 hypercholerolemia (190 to 240 mg/dL) at baseline (RR: 7.4, 95% CI:
1.8 to 31.5, p = 0.01 vs cholerol
<190 mg/dL); grade 3 hypertriglyceridemia (>750 mg/dL) at baseline (RR: 4.1, 95% CI:
1.1 to 15.1, p = 0.03 vs
triglycerides <180 mg/dL); previous HAART containing both PI and NNRTI (RR: 2.4, 95% CI:
1.3 to 4.1, p = 0.01 vs HAART
containing 2 NRTI+1/2 PI). Of the total, 75 patients (18.0%) stopped LPV/r, 85%
for adverse effects, among whom median triglycerides dropped from 294 mg/dL
(range 93 to 923) to 250 mg/dL (range 88 to 856) and median cholesterol from
203 mg/dL (range 81 to 614) to 183 mg/dL (range 83 to 436) after 3 months (p = 0.01 for both).
Conclusions: Hyperlipidemia is a frequent adverse effects
of LPV/r regimens. patients already with hyperlipidemia before LPV/r should be
closely monitored and dietary and life habits investigated.
Keywords: Dyslipidemia; Lopinavir/ritonavir; HIV
