Pere Leyes1, Montserrat Cofan2, Ana González-Cordón3, Elisa de Lazzari3, Joan Trabal1, Pere Domingo4, Eugenia Negredo5, Francesc Vidal6, Maria T Forga1, Jose M Gatell3, Emili Ros2, Esteban Martínez3. 1. Endocrinology and Nutrition Service, Hospital Clínic de Barcelona, University of Barcelona, Barcelona. 2. Endocrinology and Nutrition Service, Hospital Clínic de Barcelona, Ciber Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid. 3. Infectious Diseases Service, Hospital Clínic de Barcelona, University of Barcelona, Barcelona. 4. Infectious Diseases Department, Hospital Universitari Arnau de Vilanova & Santa Maria, Institut de Recerca Biomédica de Lleida (IRBLLeida), Universitat de Lleida, Lleida. 5. Lluita contra la Sida Foundation, Germans Trias i Pujol University Hospital, Badalona. 6. Hospital Universitari de Tarragona Joan XXIII, IISPV, Universitat Rovira I Virgili, Tarragona, Spain.
Abstract
OBJECTIVE: The aim of this study was to compare the differential effects of first-line efavirenz (EFV)-based vs. boosted lopinavir-based antiretroviral regimens on cholesterol metabolism. DESIGN: Multicentre, open-label, randomized clinical trial. METHODS:Forty-nine naive HIV-infected patients were randomized (1 : 1) to receive either ritonavir-boosted lopinavir (LPV/r) or EFV both in combination with tenofovir and emtricitabine (ClinicalTrials.gov: NCT00759070). Lipid profile and serum phytosterols and cholesterol precursors were determined at baseline and after 16 weeks. RESULTS: After 16 weeks of intervention, total and non-HDL cholesterol as well as triglyceride levels significantly increased in the LPV/r-group (+1.0 ± 0.8; +0.8 ± 0.7 and +0.8 ± 1.5 mmol/l, respectively), but not in the EFV-group (+0.4 ± 0.7; +0.4 ± 0.6 and 0.2 ± 0.5 mmol/l, respectively). Markers of cholesterol absorption (campesterol-to-cholesterol and sitosterol-to-cholesterol ratios) significantly increased in the LPV/r-group, but not in the EFV-group, whereas there were no changes in either group of the lathosterol-to-cholesterol ratio, a marker of cholesterol synthesis. CONCLUSION: Treatment with an LPV/r-based therapy increased total cholesterol relative to EFV-based therapy. Our data suggest that absorption rather than synthesis is the mechanism involved in LPV/r-associated increased total cholesterol.
RCT Entities:
OBJECTIVE: The aim of this study was to compare the differential effects of first-line efavirenz (EFV)-based vs. boosted lopinavir-based antiretroviral regimens on cholesterol metabolism. DESIGN: Multicentre, open-label, randomized clinical trial. METHODS: Forty-nine naive HIV-infectedpatients were randomized (1 : 1) to receive either ritonavir-boosted lopinavir (LPV/r) or EFV both in combination with tenofovir and emtricitabine (ClinicalTrials.gov: NCT00759070). Lipid profile and serum phytosterols and cholesterol precursors were determined at baseline and after 16 weeks. RESULTS: After 16 weeks of intervention, total and non-HDL cholesterol as well as triglyceride levels significantly increased in the LPV/r-group (+1.0 ± 0.8; +0.8 ± 0.7 and +0.8 ± 1.5 mmol/l, respectively), but not in the EFV-group (+0.4 ± 0.7; +0.4 ± 0.6 and 0.2 ± 0.5 mmol/l, respectively). Markers of cholesterol absorption (campesterol-to-cholesterol and sitosterol-to-cholesterol ratios) significantly increased in the LPV/r-group, but not in the EFV-group, whereas there were no changes in either group of the lathosterol-to-cholesterol ratio, a marker of cholesterol synthesis. CONCLUSION: Treatment with an LPV/r-based therapy increased total cholesterol relative to EFV-based therapy. Our data suggest that absorption rather than synthesis is the mechanism involved in LPV/r-associated increased total cholesterol.
Authors: Andreas D Knudsen; Claus Graff; Jonas Bille Nielsen; Magda Teresa Thomsen; Julie Høgh; Thomas Benfield; Jan Gerstoft; Lars Køber; Klaus F Kofoed; Susanne D Nielsen Journal: Sci Rep Date: 2021-10-21 Impact factor: 4.379