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Session 147 Poster Abstracts
Clinical Studies of Hyperlipidemia, Fat Redistribution, and Glucose Metabolism
Thursday, 1:30 - 3:30 pm
Hall B


847    
Dyslipidaemia in an Asian Population following Treatment for 2 Years with 5 Different Protease Inhibitor-containing Regimens: The HIV-NAT Cohort
Chris Duncombe*1, S Kerr1, A Avihingsanon1, M Boyd1, B Sopa1, D Cooper2, J Lange3, P Phanuphak1, K Ruxrungtham1, and HIV-NAT Study Group
1The HIV Netherlands, Australia, Thailand Res Collaboration, Bangkok; 2Natl Ctr in HIV Epidemiology and Clin Res, Univ of New South Wales, Sydney, Australia; and 3Intl Antiviral Therapy Evaluation Ctr, Amsterdam, The Netherlands

Background:  Protease inhibitor (PI)-containing antiretroviral therapy (ART) is frequently associated with dyslipidaemia. Data in an Asian population are limited. We describe lipid changes in a Thai population treated with 5 different PI-containing regimens.

Methods:  We compared retrospectively fasting lipid level over 2 years of therapy in 260 patients beginning treatment with 1 of 5 different PI-containing regimens. They were previously treated with nucleoside ART and were PI naive. Regimens were stavudine (d4T) + didanosine (ddI) + saquinavir (SQV), n = 46; zidovudine (AZT) + lamivudine (3TC) + SQV, n = 44; AZT+3TC+indinavir (IDV), n = 45; AZT+3TC+ritonavir-boosted IDV (IDV/r), n = 38; and efavirenz (EFV) + IDV/r, n = 58. Triglycerides were available for all patients, total cholesterol and HDL-cholesterol (HDL) levels were available for 141 patients only from the latter 3 groups. Fasting samples were collected at months 0, 3, 6, 12, and 24. Kruskal‑Wallis tests were used for primary analyses; changes from entry are expressed as median (IQR) at 24 months.

Results:  Baseline triglycerides and total cholesterol levels were equivalent in each treatment group. The proportion with triglycerides > 400 mg/dL increased from 2% at baseline to 10% at 3 months, 13% at 6 months, and 15% at 12 and 24 months. Triglyceride levels were significantly different between treatment groups at all time-points (p < 0.0001), and changes from baseline most pronounced in the patients receiving IDVr/EFV followed by IDV/r/AZT/3TC. At 24 months, triglyceride changes from baseline were:  d4T/ddI/SQV 31 (–2 to 109); AZT/3TC/SQV 20 (–4 to 77); AZT/3TC/IDV –3 (–56 to 42); AZT/3TC/IDV/r 50 (19 to 126); EFV/IDV/r 190 (109 to 307). The proportion with total cholesterol > 200 mg/dL increased from 20% at baseline to between 61 and 65% at all other time points, and was significantly different between treatment groups (p < 0.0001). As with triglycerides, the greatest changes occurred in the RTV-boosted IDV groups:  total cholesterol changes from baseline at 24 months were:  AZT/3TC/IDV 14 (‑6 to 41); AZT/3TC/RTV/IDV 45 (18 to 72); EFV/RTV/IDV 104 (73 to 154). The proportion with HDL < 40 mg/dL fell from 47% to 39% at 3 months and 42% at 24 months. Changes in HDL by treatment group were significant (p < 0.0001). At 24 months, HDL changes from baseline were:  AZT/3TC/IDV –4 (–11 to 2); AZT/3TC/IDV/r ‑5 (–11 to 1); EFV/IDV/r 15 (6 to 23).

Conclusions:  Significant dyslipidaemia was demonstrated in an Asian population after 24 months of treatment with PI-based ART. Lipid changes were most pronounced in patients receiving ritonavir-boosted IDV regimens.

Keywords: dyslipidaemia; Asian; Protease inhibitors