Background: Dyslipidemia represents a significant non-infectious comorbidity among people living with HIV. The aim of this study is to evaluate the impact on lipid profile of switches from an efavirenz (EFV) or protease inhibitor/ritonavir (PI/r)-based regimen to a rilpivirine (RPV) or a once-daily integrase inhibitor-based regimen. Methods: We analyzed data from SCOLTA prospective database. All patients with HIV-RNA < 50 copies/ml in therapy with two NRTI + EFV or PI/r were included if they switched from EFV to dolutegravir (group EFV-DTG), elvitegravir (EFV-EVG), or RPV (EFV-RPV) and from PI/r to DTG (PI/r-DTG), PI/r to EVG (PI/r-EVG), or PI/r to RPV (PI/r-RPV). Total cholesterol (TC), TC/HDL ratio, LDL-cholesterol (LDL) and triglycerides (TG) were compared at baseline, six months and one year. Comparisons among groups were performed by a general linear model. Results: Four hundred and ninety patients were enrolled, 24.9% female, mean age 47.3 years (±10.1). According to ART switch, 11.4% were classified in group EFV-DTG, 3.9% in EFV-EVG, 23.9% in EFV-RPV, 17.6% in PI/r-DTG, 17.8% in PI/r-EVG, and 25.5% in PI/r-RPV. After adjusted analysis, TC significantly decreased in all groups but EFV-EVG, TC/HDL in all but EFV-DTG and EFV-EVG, while the reduction of TG was significant only in switches to RPV (EFV-RPV and PI/r-RPV). The one year decrease of TC, TC/HDL, LDL and TG was higher in patients with higher baseline levels of the same variable (p < .0001 for all). Conclusions: In SCOLTA, all switches from PI/r regimens gave advantages on lipid profile, while stopping EFV had consistently favorable lipid effects only if replaced by RPV.

Improvement of lipid profile after switching from efavirenz or ritonavir-boosted protease inhibitors to rilpivirine or once-daily integrase inhibitors : results from a large observational cohort study (SCOLTA) / L. Taramasso, P. Tatarelli, E. Ricci, G. Madeddu, B. Menzaghi, N. Squillace, G.V. De Socio, C. Martinelli, R. Gulminetti, P. Maggi, G. Orofino, F. Vichi, A. Di Biagio, P. Bonfanti, C. Bellacosa, L. Calza, C. Abeli, B.M. Celesia, C. Grosso, A. Stagno, F. Mazzotta, G. Penco, G. Cassola, L.A. Nicolini, C. Dentone, C. Molteni, L. Palvarini, A. Scalzini, L. Carenzi, G. Rizzardini, L. Valsecchi, L. Cordier, S. Rusconi, V. Colombo, M. Galli, M. Franzetti, A. Sgrelli, E. Mazzotta, G. Parruti, P. Bagella, M.S. Mura, R. Libertone, A. Antinori, S. Di Giambenedetto, M. Guastavigna, P. Caramello. - In: BMC INFECTIOUS DISEASES. - ISSN 1471-2334. - 18:1(2018), pp. 357.1-357.8. [10.1186/s12879-018-3268-5]

Improvement of lipid profile after switching from efavirenz or ritonavir-boosted protease inhibitors to rilpivirine or once-daily integrase inhibitors : results from a large observational cohort study (SCOLTA)

L. Taramasso
;
S. Rusconi;V. Colombo;M. Galli;M. Franzetti;
2018

Abstract

Background: Dyslipidemia represents a significant non-infectious comorbidity among people living with HIV. The aim of this study is to evaluate the impact on lipid profile of switches from an efavirenz (EFV) or protease inhibitor/ritonavir (PI/r)-based regimen to a rilpivirine (RPV) or a once-daily integrase inhibitor-based regimen. Methods: We analyzed data from SCOLTA prospective database. All patients with HIV-RNA < 50 copies/ml in therapy with two NRTI + EFV or PI/r were included if they switched from EFV to dolutegravir (group EFV-DTG), elvitegravir (EFV-EVG), or RPV (EFV-RPV) and from PI/r to DTG (PI/r-DTG), PI/r to EVG (PI/r-EVG), or PI/r to RPV (PI/r-RPV). Total cholesterol (TC), TC/HDL ratio, LDL-cholesterol (LDL) and triglycerides (TG) were compared at baseline, six months and one year. Comparisons among groups were performed by a general linear model. Results: Four hundred and ninety patients were enrolled, 24.9% female, mean age 47.3 years (±10.1). According to ART switch, 11.4% were classified in group EFV-DTG, 3.9% in EFV-EVG, 23.9% in EFV-RPV, 17.6% in PI/r-DTG, 17.8% in PI/r-EVG, and 25.5% in PI/r-RPV. After adjusted analysis, TC significantly decreased in all groups but EFV-EVG, TC/HDL in all but EFV-DTG and EFV-EVG, while the reduction of TG was significant only in switches to RPV (EFV-RPV and PI/r-RPV). The one year decrease of TC, TC/HDL, LDL and TG was higher in patients with higher baseline levels of the same variable (p < .0001 for all). Conclusions: In SCOLTA, all switches from PI/r regimens gave advantages on lipid profile, while stopping EFV had consistently favorable lipid effects only if replaced by RPV.
Cholesterol; Dyslipidemia; Framingham risk score; Integrase inhibitors; Rilpivirine; Adult; Anti-HIV Agents; Benzoxazines; Cohort Studies; Drug Administration Schedule; Drug Therapy, Combination; Female; HIV Infections; HIV-Associated Lipodystrophy Syndrome; Heterocyclic Compounds, 3-Ring; Humans; Integrase Inhibitors; Lipid Metabolism; Lipids; Male; Middle Aged; Protease Inhibitors; Rilpivirine; Ritonavir; Treatment Outcome; Drug Substitution
Settore MED/17 - Malattie Infettive
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/699250
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