Background:
In patients treated with Lopinavir / Ritonavir (LPV/r), no data
are available about HDL-cholesterol (HDL-c) and Total
Cholesterol / HDL-c Ratio (TC/HDL-c) which are established CVD
predictive factors.
Methods:
Lipids measurements (at LPV/r initiation time and every 3
months) and LPV and RTV plasma concentrations (at M3 and M6)
were collected retrospectively in patients attending the clinic
of the Infectiology’s Department. Dyslipidaemia was defined as
TC > 6.2 mmol/l, HDL-c < 1 mmol/l, TC/HDL-c Ratio
> 6.5 and TG > 2.3 mmol/l.
Results:
142 patients treated with LPV/r were included (mean duration on
LPV/r : 14.4 months). 126 (89%) patients had previously received
a PI-containing regimen, 101 (71%) a NNRTI one and 6 (4%) were
treatment naïve. At baseline, 17% of patients had high TC, 63%
low HDL-c, 25% a high TC/HDL-c Ratio and 49% high TG. At M12,
the mean HDL-c increase per patient was 21% and the proportion
of dyslipidemic patients regarding HDL-c decreased to 53%. The
proportion of patients with a Ratio > 6.5 rose to 41%.
The increase in lipids means (mmol/l) is significant from the 3rd
month (6th month for ratio) and still consistent over
time until the 12th month : TC 6.09 vs 4.92
(p<0.001), HDL-c 1.06 vs 0.99 (p=0.001), TC/HDL-c ratio 6.11 vs
5.53 (p=0.03), TG 4.63 vs 2.88 (p=0.04). Among the patients with
available LPV and RTV plasma determinations at M3 (n=30), a
higher LPV trough concentration was observed in those with high
TG (6.78 vs 3.02 mg/l, p=0.05). At M6 (n=15), the elevated ratio
group had also a higher LPV trough value (9.19 vs 0.96, p=0.02).
Conclusion:
Our results suggest that LPV/r
may induce a significant rise in the HDL-c level, even after a
long term exposure. However, TC/HDL-c ratio appears to increase
significantly over the study time traducing a potential
elevation of the CVD risk. These preliminary results provide the
rational for a more precise investigation of the possible role
of therapeutic drug monitoring in the prevention of
dyslipidaemia in LPV/r treated patients.
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