Efavirenz to Nevirapine Switch in HIV-1–Infected Patients with Dyslipidemia: A Randomized, Controlled Study

Epidemiologie, Systemes d'Informations, Modelisation, Institut National de la Sante et de la Recherche Medicale U707, Paris, France.
Clinical Infectious Diseases (Impact Factor: 8.89). 08/2007; 45(2):263-6. DOI: 10.1086/518973
Source: PubMed


Many antiretroviral therapies, including efavirenz, are associated with increased serum concentrations of low-density lipoprotein
cholesterol. In a small 52-week randomized study, we found that switching from efavirenz to nevirapine was associated with
significantly decreased low-density lipoprotein cholesterol levels, compared with continuation of efavirenz therapy (P < .04). A switch to nevirapine was associated with no severe adverse events.

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    • "We found that exposure to nevirapine was associated with protection from liver steatosis. Others have reported that nevirapine can effect favorable lipid changes [21-23], but efavirenz did not favorably affected lipid metabolism in vivo[23]. In a randomized clinical trial, lipid profiles improved when efavirenz was switched to nevirapine [23]. "
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    ABSTRACT: Since Highly Active Antiretroviral Therapy (HAART) medications were made available in 2002, multiple serious side effects have been observed. However, no study has yet systematically evaluated the prevalence of liver steatosis, a very serious but treatable side effect.Objectives: This study examined the prevalence of and independent risk factors for liver steatosis in Chinese HIV-infected, HAART-experienced patients who had been diagnosed with hypertriglyceridemia. In this cross-sectional observational study, the prevalence of liver steatosis was determined by ultrasound imaging that detected diffusion in hepatic echogenicity. The risk factors associated with steatosis were evaluated with a proportional odds logistic regression model. Among 163 HIV-infected patients with hypertriglyceridemia and past HAART experience, 75(46%) patients were determined to have liver steatosis. In multivariable logistic regression model, the risk factors associated with liver steatosis were: higher triglyceride level (OR = 1.086,P = 0.026), metabolic syndromes (OR = 2.092,P = 0.024) and exposure to nucleoside reverse transcriptase inhibitor (NRTIs) ( (OR = 2.11,P = 0.001) and Stavudine (OR = 3.75,P = 0.01)). Exposure to Nevirapine (OR = 0 .41, P = 0.003) was a favorable factor for lipid metabolism in vivo and was a protective factors for liver steatosis. Chinese HIV-infected patients with hypertriglyceridemia appear to be prone to liver steatosis, especially those on NRTIs. Routine screening should be considered on their lipid panels.
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    • "[73] More recently, switch from efavirenz to nevirapine has also become a relevant hypothesis, since the former has always shown to be unable to revert PI-induced metabolic alterations [77] and has been associated with a certain degree of such side effects. Switching to nevirapine in such reports was associated with decreases in LDL-Cholesterol and increases in HDL, as well as with a reduction of neuropsychiatric effects [40, 78]. Viral suppression was maintained in all switchers and in one study also two initially viremic patients suppressed passing to nevirapine [78]. "
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    ABSTRACT: Many infections favor or are directly implicated with lipid metabolism perturbations and/or increased risk of coronary heart disease (CHD). HIV itself has been shown to increase lipogenesis in the liver and to alter the lipid profile, while the presence of unsafe habits, addiction, comorbidities, and AIDS-related diseases increases substantially the risk of cardiovascular disease (CVD) in the HIV-infected population. Antiretroviral therapy reduces such stimuli but many drugs have intrinsic toxicity profiles impacting on metabolism or potential direct cardiotoxicity. In a moment when the main guidelines of HIV therapy are predating the point when to start treating, we mean to highlight the contribution of HIV-1 to lipid alteration and inflammation, the impact of antiretroviral therapy, the decisions on what drugs to use to reduce the probability of having a cardiovascular event, the increasing use of statins and fibrates in HIV-1 infected subjects, and finally the switch strategies, that balance effectiveness and toxicity to move the decision to change HIV drugs. Early treatment might reduce the negative effect of HIV on overall cardiovascular risk but may also evidence the impact of drugs, and the final balance (reduction or increase in CHD and lipid abnormalities) is not known up to date.
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