Substitution of nevirapine or raltegravir for protease inhibitor vs. rosuvastatin treatment for the management of dyslipidaemia in HIV-infected patients on stable antiretroviral therapy (Nevrast study).

Abstract

OBJECTIVES:

An observational, prospective, cohort study was performed to compare efficacy and safety of a switch from ritonavir-boosted protease inhibitor (PI/r) to nevirapine or raltegravir with that of rosuvastatin addition to current antiretroviral therapy in HIV-infected patients with hyperlipidaemia.

METHODS:

All HIV-infected patients receiving a stable PI/r-based antiretroviral regimen, with persistently suppressed viremia, naïve to non-nucleoside analogues and to integrase strand transfer inhibitors, with mixed hyperlipidaemia, and who underwent a switch from PI/r to nevirapine (Group A) or raltegravir (Group B) or who started rosuvastatin at 10 mg daily (group C) with unchanged antiretroviral regimen were enrolled into the study.

RESULTS:

Overall, 136 patients were enrolled: 43 patients were included in the group A, 46 in the group B, and 47 in the group C. The mean age was 46.6 years, and 108 (79.4%) were males. After 48 weeks of follow-up, a significantly greater reduction in the mean low-density lipoprotein (LDL) cholesterol level was reported in group C (-28.2%) than in group A (-10.2%; p < .001) and B (-12.4%; p = .021), while a significantly greater reduction in the mean concentration of triglycerides was observed in group A (-31.2%) and B (-35.5%) than in group C (-11.9%; p = .034 and p = .004, respectively). The incidence of adverse events was <10% and comparable across the three groups.

CONCLUSION:

In HIV-positive subjects receiving a PI/r, the initiation of rosuvastatin treatment after 48 weeks yielded a greater decline in LDL cholesterol, while the switch from PI/r to nevirapine or raltegravir led to a greater decline in triglycerides.

• Authors: Leonardo Calza, Eleonora Magistrelli, Vincenzo Colangeli, Marco Borderi, Linda Bussini, Isabella Bon, Maria Carla Re, Pierluigi Viale
• Journal: Infectious diseases (London, England) (Infect Dis (Lond)) Vol. 49 Issue 10 Pg. 737-747 (Oct 2017) ISSN: 2374-4243 [Electronic] England
• PMID: 28683645 (Publication Type: Comparative Study, Journal Article, Observational Study)

Chemical References

• Anti-HIV Agents
• Anticholesteremic Agents
• Cholesterol, LDL
• HIV Integrase Inhibitors
• HIV Protease Inhibitors
• Raltegravir Potassium
• Rosuvastatin Calcium
• Nevirapine
• Ritonavir

Topics

• Adult
• Anti-HIV Agents (administration & dosage, adverse effects, therapeutic use)
• Anticholesteremic Agents (administration & dosage, adverse effects, therapeutic use)
• Antiretroviral Therapy, Highly Active
• Cholesterol, LDL (blood)
• Cohort Studies
• Drug Substitution
• Female
• HIV Infections (complications, drug therapy, virology)
• HIV Integrase Inhibitors (administration & dosage, adverse effects, therapeutic use)
• HIV Protease Inhibitors (administration & dosage, adverse effects, therapeutic use)
• HIV-1 (drug effects)
• Humans
• Hyperlipidemias (drug therapy)
• Male
• Middle Aged
• Nevirapine (administration & dosage, adverse effects, therapeutic use)
• Prospective Studies
• Raltegravir Potassium (administration & dosage, adverse effects, therapeutic use)
• Ritonavir
• Rosuvastatin Calcium (administration & dosage, adverse effects, therapeutic use)
• Viral Load
• Viremia (drug therapy)