Cardiovascular risk factors in patients on long-term treatment with nevirapine- or efavirenz-based regimens

• Published in: Journal of antimicrobial chemotherapy 2011-04, Vol.66 (4), p.896-900
• Main Authors: MAGGI, Paolo, BELLACOSA, Chiara, CARITO, Valentina, PERILLI, Francesco, LILLO, Antonio, VOLPE, Anna, TRILLO, Giovanna, ANGILETTA, Domenico, REGINA, Guido, ANGARANO, Gioacchino
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anti-HIV Agents - adverse effects; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral drugs; Benzoxazines - administration & dosage; Biological and medical sciences; Blood Chemical Analysis; Blood Glucose - analysis; Cardiovascular Diseases - chemically induced; Carotid Arteries - diagnostic imaging; Carotid Arteries - pathology; Female; Glucose; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Lipids; Lipids - blood; Low density lipoprotein; Male; Medical sciences; Medical treatment; Middle Aged; Nevirapine - adverse effects; Pharmacology. Drug treatments; Retrospective Studies; Risk Assessment; Risk factors; Ultrasonic imaging; Ultrasonography, Doppler, Color; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkq507

The aim of this study was to evaluate the cardiovascular risk among patients treated for more than 5 years with regimens based on nevirapine or efavirenz. A total of 276 patients were retrospectively evaluated, 156 of whom were treated with nevirapine and 120 with efavirenz, by examining traditional risk factors and detecting the presence of subclinical carotid lesions with colour-Doppler ultrasonography. When comparing the data at baseline and follow-up in the nevirapine group, total cholesterol, low-density lipoprotein cholesterol (LDLc) and triglycerides showed a significant decrease, while high-density lipoprotein cholesterol increased. Ultrasound data, obtained in a subgroup of 67 patients, did not show significant changes for those treated with nevirapine. In the efavirenz group, total cholesterol, LDLc, triglycerides, glycaemia, body mass index and the number of patients with a pathological ultrasound significantly increased. When comparing the two groups at baseline and follow-up, nevirapine patients had significantly higher values of total cholesterol, LDLc and triglycerides at baseline, while total cholesterol and LDLc differed non-significantly at follow-up; triglycerides became significantly lower in the nevirapine arm with respect to the efavirenz group. Glycaemia was comparable between the two groups at baseline, while it was significantly lower in the nevirapine group at follow-up. The number of pathological ultrasound findings was significantly higher in the efavirenz group at follow-up. Patients treated with nevirapine demonstrated a better lipid and glucose profile and a lower tendency to develop subclinical atherosclerotic lesions.