Switching antiretroviral therapy to minimize metabolic complications

These findings suggest maraviroc may be more lipid-neutral than efavirenz

Jordan E Lake; Judith S Currier

2010

Scholarcy highlights

  • 55 Guaraldi G, Zona S, Orlando G et al.: Visceral fat but not general adiposity is a predictor of cardiovascular disease in HIV-infected males
  • While nucleoside reverse transcriptase inhibitor-sparing switch studies involving newer agents such as raltegravir and etravirine have not yet been performed, these data suggest future science group that switching a NRTI to a protease inhibitor plus nucleoside reverse transcriptase inhibitor may not be a viable option for improving lipid parameters in HIV-infected patients
  • While the selection of an anti­ retro­viral regimen most likely to maintain virologic suppression remains the number one priority, switching antiretroviral therapy to optimize common metabolic complications including lipid abnormalities, lipoatrophy and lipohypertrophy, insulin resistance, and overall cardiovascular risk may be an effective strategy for some patients
  • While the current literature is heterogeneous with regard to both study design and outcomes reporting, data exists supporting the benefits of switching to nonthymidine analog NRTIs, the PI atazanavir, and the HIV‐1 integrase inhibitor raltegravir on some metabolic parameters
  • Whether the lipid benefits associated with ART changes will translate into a reduction in cardiovascular risk over the long term remains uncertain
  • In the SABAR study, significant improvements in median total cholesterol, non-high-density lipoprotein cholesterol, and TG were observed after 24 weeks in subjects with baseline elevations in lowdensity lipoprotein cholesterol or TG who switched to boosted atazanavir from
  • Clinicians are left to individualize the management of patients and weigh risks and benefits in determining which antiretroviral agents are most likely to be favorable for a given patient. Continued assessment of both newer classes and nontraditional combinations of agents is needed to determine whether these agents and combinations could play a role in the prevention or reversal of long-term, ARTassociated, metabolic complications

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