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Switching to nevirapine (NVP) significantly increases high-density lipoprotein cholesterol (HDL-C) in treatment-experienced patients (NEVICOR study)

  • JM Rodriguez1,
  • M Delgado2,
  • P Viciana3,
  • MA Lopez-Ruz4,
  • M Leal3,
  • F Alcacer5,
  • E Deig6,
  • A Antela7,
  • E Pedrol8 and
  • S Moreno1
Journal of the International AIDS Society201013(Suppl 4):P79

https://doi.org/10.1186/1758-2652-13-S4-P79

Published: 8 November 2010

Keywords

EfavirenzNevirapineLipid Lowering TherapyFramingham Risk ScoreStrong Inverse Relationship

Background

A strong inverse relationship between the plasma concentration of HDL-C and the incidence of coronary heart disease is widely accepted. Few interventions have succeeded to increase plasma HDL levels in HIV-infected pts. NVP has a favorable lipid profile, and clinical trials have suggested that it could have a differential effect on plasma HDL-C levels.

Methods

Prospective, single arm, multicenter study. We included patients on stable antiretroviral therapy with HIV RNA ≤50 copies/mL for at least one year that were switched to a NVP-containing regimen. Patients receiving lipid lowering therapy were excluded. HDL-cholesterol and other lipid parameters at baseline and after 24 weeks of treatment with NVP are compared.

Results

Among 130 pts included in the study, 119 (91%) could be evaluated. BL characteristics: median age 44, female 24%, current smokers 53%. Previous AIDS 29%, CD4 count 502/mm3. Time on ARV therapy 42 months. Previous therapy: efavirenz 38%, 3 NRTI 12%, PI 50%. Accompanying nucleosides were tenofovir/emtricitabine in 69%, and abacavir/lamivudine in 31%.

Table 1 shows the 24-week results of lipid profile.

Table 1

  

Mean

S. D.

N

p

Triglycerides (mg/dl)

Previous treatment

213.8

178.3

119

 
 

Nevirapine

154.6

95.3

119

<0.05

TC (mg/dl)

Previous treatment

203.6

48.0

119

 
 

Nevirapine

198.1

40.5

119

0.108

HDL-C (mg/dl)

Previous treatment

43.8

14.6

119

 
 

Nevirapine

49.3

16.8

119

<0.05

TC/HDL-C

Previous treatment

5.1

1.9

119

 
 

Nevirapine

4.3

1.3

119

<0.05

LDL (mg/dl)

Previous treatment

120.2

38.1

107

 
 

Nevirapine

119.2

32.7

107

0.705

VLDL (mg/dl)

Previous treatment

35.1

19.4

25

 
 

Nevirapine

23.6

12.6

25

<0.05

At 24 week, the proportion of patients with HDL-C>40 mg/dl were 69.7% (95%CI 60.7-77.8), compared to 52.1% (95%CI 42.8-61.3) before taking NVP (p<0.01). The Framingham risk score decreased from 7.6 to 6.6 (p<0.05) after switching to NVP.

Conclusions

Switching to NVP-containing regimens in patients on stable therapy is associated with a significant increase in HDL-C and decrease in TC/HDL-c, with an overall improvement in the Framingham score.

Authors’ Affiliations

(1)
Hospital Ramon y Cajal, Infectious Diseases, Madrid, Spain
(2)
Hospital Carlos Haya, Infectious Diseases, Malaga, Spain
(3)
Hospital Virgen del Rocio, Infectious Diseases, Sevilla, Spain
(4)
Hospital Virgen de las Nieves, Infectious Diseases, Granada, Spain
(5)
Hospital Clinico, Infectious Diseases, Valencia, Spain
(6)
Hospital General de Granollers, Infectious Diseases, Barcelona, Spain
(7)
Hospital Clinico Universitario, Infectious Diseases, Santiago, Spain
(8)
Hospital de Sant Pau I Santa Tecla, Infectious Diseases, Tarragona, Spain

Copyright

© Rodriguez et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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