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Date Posted: 18:36:14 07/24/02 Wed
Author: moonotter
Subject: New AIDS Drugs Less Likely to Cause Lipid Abnormalities

New AIDS Drugs Less Likely to Cause Lipid Abnormalities


Laurie Barclay, MD
Medscape Medical News 2002. © 2002 Medscape


July 11, 2002 — New weapons in the AIDS armamentarium are less likely to cause lipid abnormalities than other antiretroviral medications, according to a presentation at the XIV International AIDS conference in Barcelona, Spain, and a report in the July 10 issue of The Journal of the American Medical Association.
"Atazanavir is unique in that it is taken once daily, has a favorable resistance profile and, best of all, has no adverse effect on cholesterol and triglycerides," lead author Robert L. Murphy, MD, from Chicago's Northwestern University, says in a news release. "All other current protease inhibitors adversely affect lipid levels and therefore increase the risk of cardiovascular disease."

In earlier phase III studies, atazanavir was potent, safe and effective. In this study of 346 patients, switching from nelfinavir to atazanavir led to significant improvement in lipid profiles at 12 weeks, with reductions in total cholesterol, low-density lipoprotein (LDL) cholesterol and triglycerides, and increased high-density lipoprotein (HDL) cholesterol. The magnitude of the improvement was sufficient to reduce cardiovascular risk or to eliminate the need for dietary or pharmacologic intervention.

In a separate study described in JAMA, HIV patients with lipoatrophy taking a nucleoside reverse transcriptase inhibitor were randomized to either continue their initial treatment or switch to abacavir. At 24 weeks, those who had switched experienced significant but modest improvements in limb fat measured by dual-energy X-ray absorptiometry. Computed tomography also showed a trend toward improvement in subcutaneous thigh, arm and abdominal fat areas.

"Clinical lipoatrophy, as assessed subjectively, did not resolve, however, and at the rate of increase observed may take years to resolve with use of this strategy," write Andrew Carr, MD, and colleagues from the Mitochondrial Toxicity (MITOX) Study Group.

This randomized, open-label study involving 17 centers in Australia and England enrolled 111 adults (109 men) with moderate or severe lipoatrophy who were receiving stavudine or zidovudine, who had stable HIV RNA levels less than 400 copies/mL, and who had not previously received abacavir. Switching to abacavir was safe, with no unexpected adverse events and good control of HIV replication and CD4 cell count. After six months, limb fat mass had only increased by about 11% from baseline. Metabolic measures were unchanged.

"Longer follow-up of this population is needed to determine if lipoatrophy can improve clinically or even resolve," the authors write. "Other strategies under investigation include intermittent antiretroviral therapy and concurrent therapy with thiazolidinediones."

XIV International AIDS Conference: Abstract WeOrB1306. July 10, 2002.
JAMA. 2002;288(2):207-215

Reviewed by Gary D. Vogin, MD






Laurie Barclay, MD, is a staff writer with WebMD.

Medscape Medical News is edited by Deborah Flapan, an associate editor at Medscape. Please send press releases and comments to news@webmd.net.
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