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Published byChristal James Modified over 9 years ago
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Background Hypertrigliceridaemia is common in patients with HIV, especially those taking protease inhibitors (PIs) or with lipodystrophy. Although, plasma PI concentrations have been shown to be correlated with virological response there is no clear link between PI concentrations and toxicity, especially long-term side effects, such as lipid metabolism disregulation. Aim To investigate the relationship between lopinavir (LPV) plasma levels and changes in plasma triglycerides (TG), total cholesterol (TC), and high and low density lipoprotein cholesterol (HDL, LDL) in HIV-infected patients on LPV/ritonavir (r). Patients and methods Thirty HIV+ patients (Table 1) starting LPV/r + 2 nucleoside reverse transcriptase inhibitors have been enrolled and followed for 12 months. CD4+ cells, HIV-RNA, glucose, TG, TC, HDL-C and LDL-C plasma concentrations were assessed at baseline (0) and 1, 3, 6 and 12 months after LPV/r initiation. LPV trough concentrations in plasma (C trough ) were measured by HPLC- MS/MS at 1, 3, 6 and 12 months after LPV/r initiation. Correlations between LPV C trough and lipid plasma levels were investigated using linear regression and Pearson ’ s correlation. Lopinavir plasma concentrations and lipid elevation patterns in patients on lopinavir/ritonavir-containing regimens. M Boffito 1,2, S Bonora 2, A Sinicco 2, R Raiteri 2, PG Hoggard 1, SH Khoo 1, DJ Back 1, G Di Perri 2 1 University of Liverpool, Liverpool, UK; 2 University of Torino, Torino, Italy CORRESPONDENCE: MARTA BOFFITO martalbb@hotmail.com Conclusions A transient increase in TG was observed in this cohort of antiretroviral drug experienced HIV-patients. However, no correlation between LPV C trough and lipid elevations was observed, suggesting lipid metabolism alterations may not depend on drug plasma concentrations. Interestingly, our results were not in accordance with other studies performed in different countries, in similar number of patients and with similar follow-up times, which showed a significant relationship between LPV plasma concentrations and hypertriglyceridaemia. Further studies are warranted to clarify the impact of LPV plasma concentrations on lipid elevation. Figure 2: Linear regression between tryglicerides and LPV C trough Figure 1: Tryglicerides and total cholesterol concentrations over the 12 month follow-up period 10/30 RISK FACTOR (SEX/IVDU) 21/93/2541 (37-64) 30 HCV (+/-) GENDER (F/M) MEDIAN AGE (range) n Table 1: Demographics of the 30 patients enrolled in the study Results Twenty-four patients reached 12 month follow-up, while 6/30 (20%) had a major increase in TG plasma levels (to 400 mg/dL) during the first 3 months of LPV/r therapy and started lipid regulating treatment (gemfibrozil 600 mg BID, n = 4; fenofibrate 200 mg QD, n = 2). All subjects showed the expected decrease in plasma lipids when treated. Plasma TG levels showed a transient increase over the 12 month follow-up: they increased during the first 3 months of LPV/r therapy before decreasing at month 6 and 12, without reaching statistical significance (p > 0.05, ANOVA). No correlation was observed between LPV C trough and TG plasma concentrations, TG increases from baseline, TC, HDL-C and LDL-C. This was confirmed in both group of patients: the 30 enrolled and the 24 who completed the study. Moreover, comparing the 6 patients who reached a TG level > 400 mg/dL with the 24 who completed the study, no differences were observed in median LPV C trough (6274 vs 6428 ng/mL). Table 2: Tryglicerides and total cholesterol concentrations: comparison between the 30 patients enrolled and the 24 who ended the follow-up period.
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