Background:  A new formulation of lopinavir/ritonavir (LPV/r) as film-coated tablets has recently replaced the formulation of LPV/r soft gelatin capsules. Although the new formulation may show several advantages—such as no food requirements, reduced pill count, and no refrigeration required—few data are available about the bioequivalence of the 2 formulations, specially regarding effects on lipids.

Methods:  All HIV patients at our institution, who had been treated with LPV/r capsules for at least 6 months and switched in 2007 to the newer LPV/r tablets, were retrospectively analyzed. Lipid values and LPV plasma trough concentrations were examined before switching and 12 weeks thereafter. LPV plasma concentrations were measured by a validated high-performance liquid chromatography with ultraviolet detector (HPLC-UV) method. Patients taking lipid-lowering agents were excluded from this analysis.

Results:  A total of 40 patients were identified (83% male; median age, 44 years old [IQR 41 to 48], 95.1% Caucasian). LPV plasma trough concentrations were significantly higher with LPV/r tablets than with the old LPV/r capsules. No significant differences were seen for total cholesterol and LDL cholesterol when comparing both LPV/r formulations. In contrast, triglycerides were significantly increased and HDL cholesterol reduced with LPV/r tablets compared to capsules. The ratio of total cholesterol (TC) to HDL cholesterol was significantly higher with tablets than capsules.

Conclusions:  Higher LPV plasma trough concentrations with the new formulation of LPV/r tablets compared with the old capsules are associated with increases in triglycerides and reductions in the TC:HDL ratio, which may be relevant in patients with cardiovascular risk.