1 / 14

XVI International AIDS Conference Abstract # ThABO101

Long-Term Changes in Lipids and Glucose/Insulin among HIV-Infected Antiretroviral Naïve Persons Randomized to PI vs. NNRTI vs. PI+NNRTI-based strategies: Results of the CPCRA 061 Metabolic Study.

nola-watson
Download Presentation

XVI International AIDS Conference Abstract # ThABO101

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Long-Term Changes in Lipids and Glucose/Insulin among HIV-Infected Antiretroviral Naïve Persons Randomized to PI vs. NNRTI vs. PI+NNRTI-based strategies: Results of the CPCRA 061 Metabolic Study J. Shlay, G. Bartsch, G. Peng, J. Wang, C. Gibert, F. Visnegarwala, S. Raghavan, Y Xiang, M. Farrough, H. Perry, D. Kotler, C. Grunfeld, W. El-Sadr for the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA) XVI International AIDS Conference Abstract # ThABO101

  2. Background • Morphologic changes (lipoatrophy and lipohypertrophy), insulin resistance, and dyslipidemia are important metabolic consequences of antiretroviral therapy in patients with HIV/AIDS • However, long-term comparative data on the metabolic effects of initiating different ART strategies in ART-naïve patients are limited

  3. Objectives • To assess long-term changes in metabolic parameters and body composition among antiretroviral-naïve patients randomized to three highly active antiretroviral therapy (ART) strategies

  4. Patient meets eligibility requirements Randomized to 3 strategy arms (1:1:1) N=1,397 PI + NRTIs N=470 NNRTI + NRTIsN=463 PI + NNRTI + NRTI(s) N=464 PI Strategy N=141 in Metabolic substudy NNRTI StrategyN=141in Metabolic substudy PI + NNRTI Strategy N=140 in Metabolic substudy C•P•C•R•A

  5. Baseline Characteristics – 1* PI (N=141) NNRTI (N=141) PI + NNRTI (N=140) Age (years) 37 38 39 Female (%) 26 23 17 RaceAfrican American (%) 61 62 59 Prior AIDS (%) 38 39 32 CD4 (cells/mm3) 235 206 204 RNA (log10 copies/mL) 4.9 5.0 5.0 * No significant differences among treatment strategies

  6. Baseline Characteristics - 2 PI (N=141) NNRTI (N=141) PI + NNRTI (N=140) P-Value Triglycerides (mg/dL) 122.9 129.3 146.4 NS Total Cholesterol (mg/dL) 160.0 157.1 168.7 *HDL Cholesterol (mg/dL) 39.0 36.8 35.3 NSLDL Cholesterol (mg/dL) 96.7 94.1 105.3 * Glucose (mg/dL) 86.1 88.6 86.4 NS Insulin (µ/mL) 8.5 9.9 10.4 NS * Significant differences among treatment strategies: p < 0.05

  7. ART Prescribed after Randomization PI(N=141) NNRTI(N=140) PI + NNRTI(N=140) PI (%)NFV 58 0 64 IDV 12 0 11RTV-boosted 26 0 22Other 4 0 2 NNRTI (%)EFV 0 63 50NVP 1 37 49Other 0 0 1 NRTI (%)ZDV + 3TC 53 53 38d4T + 3TC 19 19 10ABC + 3TC 11 12 16ddI + d4T 12 12 14Single NRTI 0 0 19Other 6 4 2

  8. Change in LDL Cholesterol* * If triglycerides ≥ 400, direct LDL, otherwise calculated LDL

  9. Change in HDL Cholesterol

  10. Change in Triglycerides

  11. Change in Insulin

  12. Conclusions - I • PI+NNRTI strategy associated with a greater increase in LDL-C and triglycerides compared to the PI or NNRTI strategies; no significant differences noted between PI and NNRTI strategies • LDL-C levels increased primarily within the first few months after initiation of ART, followed by a decline during the remainder of follow-up

  13. Conclusions - II • Unlike LDL-C, triglyceride levels did not decline with continued therapy • Significantly greater increases in mean HDL-C seen with the NNRTI strategy compared to the PI strategy • PI+NNRTI strategy should be avoided unless no other options are available

  14. Conclusions - III • Increases in insulin and glucose were noted during follow-up, with no differences by ART strategy • Increases in insulin and glucose were gradual and continued throughout follow-up, unlike the pattern of changes noted with the lipids • Findings support the need for ongoing monitoring of glucose levels as well as for the development of diabetes, irrespective of ART regimen used

More Related