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Nevirapine better than efavirenz at raising HDL cholesterol
  NEW YORK (Reuters Health) - In antiretroviral therapy-naïve HIV-infected patients, treatment with the non-nucleoside reverse transcriptase inhibitor (NNRTI) nevirapine leads to significantly greater increases in high-density lipoprotein cholesterol (HDL-c) than does treatment with the NNRTI efavirenz, suggest results of a prospective study.
This may be something to consider when selecting the most appropriate initial ART regimen, particularly for those patients who are at increased risk for cardiovascular disease, study investigators write in the kick-off issue of Public Library of Science Medicine (PLoS Medicine).
In the study, Dr. Frank van Leth from the University of Amsterdam in the Netherlands and an international team analyzed changes over 48 weeks in the lipid profiles of 417 previously ART-naïve patients allocated to nevirapine and 289 allocated to efavirenz. All patients were also taking stavudine and lamivudine during the study.
HDL-c levels increased 42.5% in patients taking nevirapine compared with 33.7% in patients taking efavirenz.
Additionally, the increase in total cholesterol (TC) was lower in nevirapine- than efavirenz-treated patients (26.9% vs 31.1%), which resulted in a decrease of 4.1% in the TC:HDL-c ratio in the nevirapine group compared with an increase of 5.9% in TC:HDL-c ratio in the efavirenz group.
Increases in non-HDL-c were smaller with nevirapine than with efavirenz (24.7% vs 33.6%) as were the increases with triglycerides (20.1% vs 49.0%) and low-density lipoprotein cholesterol (35.0% vs 40.0%).
"These differences remained, or even increased, after adjusting for changes in HIV-1 RNA and CD4+ cell levels, indicating an effect of the drugs on the lipids over and above that which may be explained by suppression of HIV-1 infection," the authors point out.
They conclude, based on their findings, that nevirapine-containing ART "may be expected to result in a reduced risk of coronary heart disease."
PLoS Medicine 2004;1:e19.

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