Improved Lipid Profiles and Maintenance of Virologic Control in Heavily Pretreated HIV-Infected Patients Who Switched from Stavudine to Tenofovir Treatment

University of Cologne, Köln, North Rhine-Westphalia, Germany
Clinical Infectious Diseases (Impact Factor: 8.89). 02/2006; 42(1):145-7. DOI: 10.1086/498516
Source: PubMed


A retrospective chart analysis of 66 human immunodeficiency virus type 1 (HIV-1)— infected patients whose treatment was switched
from stavudine to tenofovir without any other treatment changes was conducted. The mean total cholesterol values decreased
significantly within 3 months after the tenofovir substitution and remained significantly less than baseline values during
18 months of follow-up (mean decrease, 36 mg/dL; P =.002). Regimens containing tenofovir provided effective control of HIV-1 infection, with stable CD4+ cell counts and continued suppression of plasma HIV-1 level following the treatment switch from stavudine.

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    • "Switches to tenofovir from thymidine analogues [39], mainly stavudine [34, 79–81], have showed some good changes in the lipid profile. In particular, a study on 352 HIV-infected subjects followed for 48 weeks found a sustained reduction in median TC (−17.5 mg/dL; P < .001), "
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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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