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Clinical Trial
. 2004 Oct;1(1):e19.
doi: 10.1371/journal.pmed.0010019. Epub 2004 Oct 19.

Nevirapine and efavirenz elicit different changes in lipid profiles in antiretroviral-therapy-naive patients infected with HIV-1

Frank van Leth  1 , Prahpan Phanuphak, Erik Stroes, Brian Gazzard, Pedro Cahn, François Raffi, Robin Wood, Mark Bloch, Christine Katlama, John J P Kastelein, Mauro Schechter, Robert L Murphy, Andrzej Horban, David B Hall, Joep M A Lange, Peter Reiss
Affiliations
Clinical Trial

Nevirapine and efavirenz elicit different changes in lipid profiles in antiretroviral-therapy-naive patients infected with HIV-1

Frank van Leth et al. PLoS Med. 2004 Oct.

Erratum in

  • PLoS Med. 2004 Dec;1(3):e73

Abstract

Background: Patients infected with HIV-1 initiating antiretroviral therapy (ART) containing a non-nucleoside reverse transcriptase inhibitor (NNRTI) show presumably fewer atherogenic lipid changes than those initiating most ARTs containing a protease inhibitor. We analysed whether lipid changes differed between the two most commonly used NNRTIs, nevirapine (NVP) and efavirenz (EFV).

Methods and findings: Prospective analysis of lipids and lipoproteins was performed in patients enrolled in the NVP and EFV treatment groups of the 2NN study who remained on allocated treatment during 48 wk of follow-up. Patients were allocated to NVP (n = 417), or EFV (n = 289) in combination with stavudine and lamivudine. The primary endpoint was percentage change over 48 wk in high-density lipoprotein cholesterol (HDL-c), total cholesterol (TC), TC:HDL-c ratio, non-HDL-c, low-density lipoprotein cholesterol, and triglycerides. The increase of HDL-c was significantly larger for patients receiving NVP (42.5%) than for patients receiving EFV (33.7%; p = 0.036), while the increase in TC was lower (26.9% and 31.1%, respectively; p = 0.073), resulting in a decrease of the TC:HDL-c ratio for patients receiving NVP (-4.1%) and an increase for patients receiving EFV (+5.9%; p < 0.001). The increase of non-HDL-c was smaller for patients receiving NVP (24.7%) than for patients receiving EFV (33.6%; p = 0.007), as were the increases of triglycerides (20.1% and 49.0%, respectively; p < 0.001) and low-density lipoprotein cholesterol (35.0% and 40.0%, respectively; p = 0.378). 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 lipids over and above that which may be explained by suppression of HIV-1 infection. The increases in HDL-c were of the same order of magnitude as those seen with the use of the investigational HDL-c-increasing drugs.

Conclusion: NVP-containing ART shows larger increases in HDL-c and decreases in TC:HDL-c ratio than an EFV-containing regimen. Based on these findings, protease-inhibitor-sparing regimens based on non-nucleoside reverse transcriptase inhibitor, particularly those containing NVP, may be expected to result in a reduced risk of coronary heart disease.

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Conflict of interest statement

Competing Interests: FvL has received travel grants and honoraria for presentations from Boehringer Ingelheim and travel grants from GlaxoSmithKline. PP has received research grants and honoraria for speaking from GlaxoSmithKline, Bristol-Myers Squibb, Roche, Merck Sharp and Dohme, and Boerhinger Ingleheim. BG has received grants and honoraria from Abbott Pharmaceuticals, GlaxoSmithKline, Bristol-Myers Squibb, Gilead, and Boehringer Ingleheim. FR has received research grants and honoraria from GlaxoSmithKline, Roche, Bristol-Myers Squibb, Abbott, and Boehringer Ingleheim. RW is conducting clinical research supported by GlaxoSmithKline, Boehringer Ingelheim, Pfizer, and Bristol-Myers Squibb. MB is currently conducting clinical studies supported by Boehringer Ingelheim, Bristol-Myers Squibb, and Merck. CK has received grants and honoraria for speaking from Bristol-Myers Squibb, GlaxoSmithKline, Boehringer Ingelheim, Bayer, and Roche. MS has received research grants, travel grants, and honoraria for speaking from Abbott, Bristol-Myers Squibb, Boehringer Ingelheim, GlaxoSmithKline, Gilead, Merck, and Roche. RLM has received honoraria for consultancies from Boehringer Ingelheim and Bristol-Myers Squibb. AH has received honoraria for presentations from Boehringer Ingleheim. DBH is employed by Boehringer Ingelheim, the manufacturer of one of the trial medications. JMAL has received honoraria as an advisor for GlaxoSmithKline, Boehringer Ingelheim, Bristol-Myers Squibb, Roche, Merck Sharp and Dohme, Schering-Plough, Bayer, Shire Pharmaceuticals, Agouron/Pfizer, and Virco/Tibotec. PR, in the last five years, has received honoraria for speaking engagements from Boehringer Ingelheim.

JMAL is a member of the editorial board of PLoS Medicine.

Figures

Figure 1
Figure 1. Change in Plasma Concentrations of Lipids and Lipoproteins
Adjusted for sex, region, pVL decrease, and CD4+-cell increase.
See this image and copyright information in PMC

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