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Mafumhe TF, Regalado G, Olojede SO, Lawal SK, Azu OO. Comparison of Switching Between Antiretroviral Agents Versus Introducing Lipid-lowering Agents for HAART-induced Dyslipidemia. Clin Ther 2024; 46:e114-e124. [PMID: 38851959 DOI: 10.1016/j.clinthera.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 11/08/2023] [Accepted: 04/21/2024] [Indexed: 06/10/2024]
Abstract
PURPOSE Highly active antiretroviral therapy (HAART) has brought a significant reduction in HIV/AIDS-related morbidity and mortality. However, metabolic abnormalities (eg, dyslipidemias) have continued to pose significant challenges, warranting a switch between antiretroviral agents and/or the introduction of a statin. Hence, the purposes of this study was to compare the efficacy of switching between antiretroviral agents versus introducing a statin in the long-term management of HAART-induced dyslipidemia in people living with HIV, and to identify the most potent agent in switching therapies. METHODS A comprehensive literature search of PubMed and Medline identified articles published from the years 2000 to 2020 in the English language, resulting in 84 articles, 30 of which were selected based on inclusion and exclusion criteria. Information on primary and secondary outcomes was extracted. Statistical analysis was done on the variables, and the differences between groups were considered significant at P < 0.05. FINDINGS Statin use was associated with significant reductions in triglycerides and total cholesterol (TC) at 6 weeks (both, P < 0.01). A switch of antiretroviral agents was associated with gradual reductions in TC and triglycerides for up to 48 weeks (both, P < 0.01). Statin use was associated with a reduced CD4 count at 24 weeks (P < 0.01). A switch of antiretroviral agents was associated with an increased CD4 count at 48 weeks (P < 0.01). IMPLICATIONS Statins were as effective as switching antiretroviral therapies in the short-term management of TC and triglycerides in patients with HAART-induced dyslipidemia.
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Affiliation(s)
| | - Gideon Regalado
- Department of Surgery and Anaesthesiology, School of Medicine, University of Namibia, Windhoek, Namibia
| | - Samuel Oluwaseun Olojede
- Division of Human Anatomy, Department of Human Biology, Faculty of Medicine and Health Sciences, Walter Sisulu University, Nelson Mandela Drive, Mthatha, South Africa
| | - Sodiq Kolawole Lawal
- School of Nursing, Faculty of Health Sciences, Private Bag UB 002, Plot 4775, Notwane Road, University of Botswana, Gaborone, Botswana
| | - Onyemaechi Okpara Azu
- Department of Medical Biosciences, University of the Western Cape, Bellville, Cape Town 7535, South Africa.
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Calza L, Colangeli V, Borderi M, Coladonato S, Tazza B, Fornaro G, Badia L, Guardigni V, Verucchi G, Viale P. Improvement in liver steatosis after the switch from a ritonavir-boosted protease inhibitor to raltegravir in HIV-infected patients with non-alcoholic fatty liver disease. Infect Dis (Lond) 2019; 51:593-601. [PMID: 31219362 DOI: 10.1080/23744235.2019.1629008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: The ritonavir-boosted protease inhibitor (PI/r) use has been associated with several metabolic abnormalities, and the non-alcoholic fatty liver disease (NAFLD) is becoming a very frequent comorbidity among HIV-infected patients. Methods: We performed an observational, prospective study of HIV-infected patients with NAFLD, receiving one PI/r plus two nucleoside analogues, who switched from the PI/r to raltegravir or were treated only with lifestyle modification, maintaining antiretroviral therapy unchanged. Changes in liver steatosis after 12 months were evaluated by transient elastography and measurement of controlled attenuation parameter (CAP). Results: As a whole, 61 patients (46 males; median age, 55.4 years) were enrolled, and 32 of them have been switched from PI/r to raltegravir. At baseline, median CAP was 259 dB/m, 28 (45.9%) subjects had a moderate-to-severe hepatic steatosis (CAP ≥260 dB/m), and 19 patients (31.1%) had elevated aminotransferases. Type-2 diabetes mellitus was present in 5 persons, and chronic HCV coinfection in 4. At month 12, the median decrease in CAP values was -27 dB/m in patients switched to raltegravir and -11 dB/m in those with unchanged cART (p = .021). The number of patients with CAP ≥260 dB/m decreased from 16 to 6 (-62.5%) in patients switched to raltegravir and from 12 to 8 (-33.3%) in the other group (p = .037). Conclusion: After 12 months, HIV-infected patients with NAFLD switching from a PI/r to raltegravir showed a significantly greater decrease in the hepatic steatosis degreee in comparison with those with unchanged cART and treated only with lifestyle modification.
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Affiliation(s)
- Leonardo Calza
- a Department of Medical and Surgical Sciences, Clinic of Infectious Diseases and Microbiology Unit*, "Alma Mater Studiorum" , University of Bologna, S. Orsola-Malpighi Hospital, Bologna , Italy
| | - Vincenzo Colangeli
- a Department of Medical and Surgical Sciences, Clinic of Infectious Diseases and Microbiology Unit*, "Alma Mater Studiorum" , University of Bologna, S. Orsola-Malpighi Hospital, Bologna , Italy
| | - Marco Borderi
- a Department of Medical and Surgical Sciences, Clinic of Infectious Diseases and Microbiology Unit*, "Alma Mater Studiorum" , University of Bologna, S. Orsola-Malpighi Hospital, Bologna , Italy
| | - Simona Coladonato
- a Department of Medical and Surgical Sciences, Clinic of Infectious Diseases and Microbiology Unit*, "Alma Mater Studiorum" , University of Bologna, S. Orsola-Malpighi Hospital, Bologna , Italy
| | - Beatrice Tazza
- a Department of Medical and Surgical Sciences, Clinic of Infectious Diseases and Microbiology Unit*, "Alma Mater Studiorum" , University of Bologna, S. Orsola-Malpighi Hospital, Bologna , Italy
| | - Giacomo Fornaro
- a Department of Medical and Surgical Sciences, Clinic of Infectious Diseases and Microbiology Unit*, "Alma Mater Studiorum" , University of Bologna, S. Orsola-Malpighi Hospital, Bologna , Italy
| | - Lorenzo Badia
- a Department of Medical and Surgical Sciences, Clinic of Infectious Diseases and Microbiology Unit*, "Alma Mater Studiorum" , University of Bologna, S. Orsola-Malpighi Hospital, Bologna , Italy
| | - Viola Guardigni
- a Department of Medical and Surgical Sciences, Clinic of Infectious Diseases and Microbiology Unit*, "Alma Mater Studiorum" , University of Bologna, S. Orsola-Malpighi Hospital, Bologna , Italy
| | - Gabriella Verucchi
- a Department of Medical and Surgical Sciences, Clinic of Infectious Diseases and Microbiology Unit*, "Alma Mater Studiorum" , University of Bologna, S. Orsola-Malpighi Hospital, Bologna , Italy
| | - Pierluigi Viale
- a Department of Medical and Surgical Sciences, Clinic of Infectious Diseases and Microbiology Unit*, "Alma Mater Studiorum" , University of Bologna, S. Orsola-Malpighi Hospital, Bologna , Italy
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Innes S, Patel K. Noncommunicable diseases in adolescents with perinatally acquired HIV-1 infection in high-income and low-income settings. Curr Opin HIV AIDS 2018; 13:187-195. [PMID: 29432231 PMCID: PMC5934760 DOI: 10.1097/coh.0000000000000458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Perinatally HIV-infected adolescents may be at increased risk of noninfectious comorbidities later in life. This review summarizes recent advances in the understanding of noncommunicable diseases (NCD) among HIV-infected adolescents in high-income and lower middle-income countries, and identifies key questions that remain unanswered. We review atherosclerotic vascular disease (AVD), chronic bone disease (CBD), chronic kidney disease (CKD), and chronic lung disease (CLD). RECENT FINDINGS Persistent immune activation and inflammation underlie the pathogenesis of AVD, highlighting the importance of treatment adherence and maintenance of viral suppression, and the need to evaluate interventions to decrease risk. Tenofovir disoproxil fumarate (TDF) and trials of vitamin D supplementation have been the focus of recent studies of CBD with limited studies to date evaluating tenofovir alafenamide as an alternative to TDF for decreasing risk for bone and renal adverse effects among HIV-infected adolescents. Recent studies of CKD have focused primarily on estimating prevalence in different settings whereas studies of CLD are limited. SUMMARY As perinatally HIV-infected children age into adolescence and adulthood with effective long-term ART, it is necessary to continue to evaluate their risks for noninfectious comorbidities and complications, understand mechanisms underlying their risks, and identify and evaluate interventions specifically in this population.
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Affiliation(s)
- Steve Innes
- Family Infectious Diseases Clinical Research Unit (FAMCRU), Stellenbosch University, and Department of Paediatrics and Child Health, Tygerberg Children’s Hospital, Cape Town, South Africa
| | - Kunjal Patel
- Department of Epidemiology, Harvard T.H. Chan School of Public Health and Center for Biostatistics in AIDS Research (CBAR), Boston, MA, USA
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