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Comparative changes of lipid levels in treatment-naive, HIV-1-infected adults treated with dolutegravir vs. efavirenz, raltegravir, and ritonavir-boosted darunavir-based regimens over 48 weeksGå till Stäng Överst

Quercia R, Roberts J, Martin-Carpenter L, Zala C.

Clin Drug Investig. 2015 Mar;35(3):211-9.

Background and objectives

Long-term use of antiretroviral therapy (ART) to treat HIV infection has been associated with dyslipidemia and metabolic and cardiovascular complications.  Available options for patients at risk of cardiovascular disease include antiretroviral drugs with improved lipid profiles.  Dolutegravir is one of a new generation of HIV integrase inhibitors recently incorporated into the US Department of Health and Human Services, German, Spanish, and   Italian   HIV   treatment guidelines as a preferred first-line third agent in combination with dual nucleoside reverse transcriptase inhibitor (NRTI) backbone therapies. To understand the lipid profile of dolutegravir in the context of combination ART, we analyzed the lipid outcomes at 48 weeks in ART-naive participants in four phase IIb–IIIb clinical trials.

Methods

Variables included in this analysis were total cholesterol (TC), low-density lipoprotein (LDL) cholesterol (LDL-C), high-density lipoprotein (HDL) cholesterol (HDL-C), TC/HDL ratio, and triglycerides at baseline and week 48.

Results

In a comparative analysis, dolutegravir demonstrated a broadly neutral effect on lipids versus efavirenz or ritonavir-boosted darunavir; in both comparisons, patients taking   dolutegravir   exhibited   smaller   increases   in TC, LDL-C, and triglyceride levels. In comparison with raltegravir, dolutegravir   exhibited   a   similar   lipid   profile, including small increases in TC, LDL-C, and triglyceride levels for both agents. In the pooled dolutegravir analysis, minimal   increases   in   LDL-C   and   triglycerides   were observed but mean values at 48 weeks remained below National   Cholesterol   Education   Program   target   levels. HDL-C levels increased at 48 weeks, and the mean TC/HDL-C ratio was 0.6 at 48 weeks; these values are associated with a lower risk of cardiovascular disease.

Conclusions

Together, these data show that dolutegravir has a safer lipid profile in combination ART and provides an important treatment option for older patients who may have other risk factors for metabolic syndrome or cardiovascular disease.

Abstract copyright:  ©The Author(s) 2015. This article is published with open access at Springerlink.com.
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