Substitution of nevirapine or raltegravir for protease inhibitor vs. rosuvastatin treatment for the management of dyslipidaemia in HIV-infected patients on stable antiretroviral therapy (Nevrast study). Issue 10 (3rd October 2017)

• Record Type: Journal Article
• Authors: Calza, Leonardo; Magistrelli, Eleonora; Colangeli, Vincenzo; Borderi, Marco; Bussini, Linda; Bon, Isabella; Re, Maria Carla; Viale, Pierluigi
• Is Part Of: Infectious diseases. Volume 49:Issue 10(2017:Oct.)
• Page Start: 737
• Page End: 747
• Publication Date: 2017-10-03
• Subjects: Hyperlipidaemia -- protease inhibitor -- integrase inhibitor -- switch -- statin; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; 616.9
• DOI: 10.1080/23744235.2017.1339325
• Languages: English
• ISSNs: 2374-4235

Abstract

Abstract: Objectives: An observational, prospective, cohort study was performed to compare efficacy and safety of a switch from ritonavir-boosted protease inhibitor (PI/r) to nevirapine or raltegravir with that of rosuvastatin addition to current antiretroviral therapy in HIV-infected patients with hyperlipidaemia. Methods: All HIV-infected patients receiving a stable PI/r-based antiretroviral regimen, with persistently suppressed viremia, naïve to non-nucleoside analogues and to integrase strand transfer inhibitors, with mixed hyperlipidaemia, and who underwent a switch from PI/r to nevirapine (Group A) or raltegravir (Group B) or who started rosuvastatin at 10 mg daily (group C) with unchanged antiretroviral regimen were enrolled into the study. Results: Overall, 136 patients were enrolled: 43 patients were included in the group A, 46 in the group B, and 47 in the group C. The mean age was 46.6 years, and 108 (79.4%) were males. After 48 weeks of follow-up, a significantly greater reduction in the mean low-density lipoprotein (LDL) cholesterol level was reported in group C (-28.2%) than in group A (−10.2%; p < .001) and B (−12.4%; p = .021), while a significantly greater reduction in the mean concentration of triglycerides was observed in group A (−31.2%) and B (−35.5%) than in group C (−11.9%; p = .034 and p = .004, respectively). The incidence of adverse events was <10% and comparable across the three groups. Conclusion: In HIV-positive subjects receiving a PI/r, the initiation of rosuvastatin treatment after 48 weeks yielded a greater decline in LDL cholesterol, while the switch from PI/r to nevirapine or raltegravir led to a greater decline in triglycerides.