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  XVI International AIDS Conference
Toronto Canada
August 13 - 18, 2006
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Reyataz Lipid Changes
 
 
  Reported by Jules Levin
XVI IAC Toronto, Aug 2006
 
Here are 2 poster reports from IAC.
 
Impact of atazanavir versus atazanavir/ritonavir-based regimens on the lipid profile of HIV patients in clinical practice
 
AIDS 2006 - XVI International AIDS Conference, 2006
Abstract no. CDB0712.
 
Drummond J.1, Beique L.2, Woodend K.3, Angel J.2, Giguere P.1 1The Ottawa Hospital, Pharmacy Department, Ottawa, Canada, 2The Ottawa Hospital, Infectious Diseases Department, Ottawa, Canada, 3University of Ottawa, Faculty of Health Sciences, School of Nursing, Ottawa, Canada
 
Background: Little is known about the impact of unboosted atazanavir- (ATV) versus boosted atazanavir-based regimens (ATV/r) on the lipid profile of HIV patients. The primary objective is to compare the lipid changes at 3 months in patients taking ATV vs. ATV/r. The secondary objective is to compare the lipid changes in patients with different baseline lipid levels.
 
Methods: A retrospective chart review of patients taking ATV and ATV/r was performed. Patients initiating lipid-lowering agents or who had any changes in their lipid-lowering agents while on atazanavir were excluded. Demographics and clinical data were collected. A crude analysis with repeated measures ANOVA was performed.
 
RESULTS
 

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For TG, there was a significant decrease over time when both groups (ATV and ATV/r) were combined (p=0.015), but there was no difference between patients taking ATV and ATV/r. For TC, there was a non significant decrease in TC over time when both groups were combined, and no difference between the two groups. Adding baseline dyslipidemia into the model did not affect the results. Conclusions: There does not appear to be a difference between ATV and ATV/r on TC and TG over the first three months of therapy.
 
Comparison of the changes in high density cholesterol (HDL) among efavirenz (EFV) and atazanavir (TAZ) users and characterization of factors associated with this change
 
AIDS 2006 - XVI International AIDS Conference, 2006
Abstract no. CDB0651.
 
Ganesan A.1, Mccarthy S.2, Furtek K.3, Crum N.3, Petersen K.4, Decker C.4, Qin J.5, Mckaig R.6, Tasker S.4 1Henry M Jackson Foundation ,TACC and National Naval Medical Center, Division of Infectious Diseases, Bethesda, United States, 2Henry M Jackson Foundation and TACC, Bethesda, United States, 3Henry M Jackson Foundation and TACC, San-Diego, United States, 4National Naval Medical Center, Bethesda, United States, 5National Institute of Allergy and Infectious Diseases, Bethesda, United States, 6DAIDS, Rockledge, United States
 
Background: Both efavirenz and atazanavir are attractive choices for antiretroviral therapy (ART), given their once daily dosing, tolerability and potency. While the total and low density cholesterol sparing effects of atazanavir are well described, changes in HDL have not been consistent. In contrast efavirenz use increases serum HDL. Given that low HDL is an independent risk factor for coronary artery disease (CAD), we evaluate the effects of these two regimens on serum HDL
 
Methods: Patients receiving TAZ or EFV-based regimens with baseline and follow up lipid profiles were included in this retrospective review. Propensity scores were used to adjust for possible selection biases. Paired T and stratified Wilcoxon tests were used for the intra and intergroup comparisons. Linear regression models were used to identify factors predictive of changes in HDL among atazanavir and efavirenz users adjusting for age, sex, race, baseline HDL and CD4, nadir CD4, cumulative stavudine and ART use, hepatitis C and diabetes mellitus.
 
Results:
111 patients were on atazanavir (median age- 40, 93% male, 44% African American(AA) with a mean/median baseline HDL of 33.7/32mg/dl respectively).
 
34 patients were on EFV (median age-37, 97% males, 47% AA with a mean/ median baseline HDL of 37.7/33 mg/dl).
 
The mean increase in HDL from baseline in the efavirenz and atazanavir group were 6.6 (p<0.02) and 3.5 (p<0.001) mg/dl, respectively.
 
There was no difference in the changes in HDL among atazanavir and efavirenz users using a stratified Wilcoxon test (p=0.14).
 
Only baseline HDL was predictive and inversely correlated with changes in HDL among both efavirenz and atazanavir users p<0.0001 and p<0.001, respectively.
 
The authors concluded that both atazanavir and efavirenz use results in comparable increases in HDL; the largest increases are seen in subjects with the lowest baseline HDL. Given these effects both drugs may offer an advantage in patients with known risk factors for cardiovascular risks.
 
Lipid profile in patients who switched treatment to boosted atazanavir in the south of Brazil
 
AIDS 2006 - XVI International AIDS Conference, 2006
Abstract no. CDB0609.
 
Marques L.1, Fernandes J.1, Bay M.1, Falci D.1, Sprinz E.1, Villavicencio F.1 1Universidade Federal do Rio Grande do Sul, Hospital de Clïnicas de Porto Alegre, Porto Alegre, Brazil
 
Background: Highly active antiretroviral therapy (HAART) is related to hyperlipidemia and the protease inhibitor, atazanavir, is said to have a more friendly profile to the lipids. This study evaluated these changes at 6 months of follow-up in patients who switched treatment to boosted atazanavir (for any reason) in a population based in the south of Brazil.
 
Methods: Individuals older than 18 years, that switched therapy to boosted atazanavir while maintaining the two backbone nucleosides analogues from March, 2004 to March, 2005, that have previous and after 6 months on treatment fasting lipids measures with undetectable viral load were selected from SOBRHIV cohort database, Porto Alegre, Brazil. T-student and chi-square statistical tests were used to analyze data.
 
Results:
A total of 53 patients were selected (36 males, 68%). The mean age was 45 years.
 
At baseline, mean total cholesterol was 217 mg/dL; HDL, 42 mg/dL; and, triglycerides, 384 mg/dL.
 
At 6 months, total cholesterol was 196 mg/dL; HDL, 44 mg/dL; and, triglycerides, 243 mg/dL.
 
In this period there was 21mg/dL decrease in mean total cholesterol, (CI95%: 35.3:-6.1; p<0,01)) and 141 mg/dL mean reduction in triglycerides (CI95%: 207.5:-74.3; p<0,01).
 
There was no statistical difference in HDL levels.
 
The results did not differ as regards to the backbone utilized nucleosides (d4T or not).
 
There was no virological failure in the observed period.
 
The authors concluded... in this population based study we observed a significant improve in lipids (mainly triglycerides). The switch to boosted atazanavir is an option to decrease lipids while keeping viral suppression.