Lipid levels and changes in body fat distribution in treatment-naive, HIV-1-infected adults treated with rilpivirine or efavirenz for 96 weeks in the ECHO and THRIVE trials
Journal
Clinical Infectious Diseases
Journal Volume
59
Journal Issue
3
Pages
425-434
Date Issued
2014
Author(s)
Tebas P.
Sension M.
Arribas J.
Duiculescu D.
Florence E.
Wilkin T.
Vanveggel S.
Stevens M.
Deckx H.
Abstract
Background. Pooled ECHO/THRIVE lipid and body fat data are presented from the ECHO (Efficacy Comparison in Treatment-Na?ve, HIV-Infected Subjects of TMC278 and Efavirenz) and THRIVE (TMC278 Against HIV, in a Once-Daily Regimen Versus Efavirenz) trials. Methods. We assessed the 96-week effects on lipids, adverse events (AEs), and body fat distribution (dual-energy x-ray absorptiometry) of rilpivirine (RPV) and EFV plus 2 nucleoside/nucleotide reverse transcriptase inhibitors (N[t]RTIs) in treatment-naive adults infected with human immunodeficiency virus type 1 (HIV-1). Results. Rilpivirine produced minimal changes in total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides. Compared with RPV, EFV significantly (P < .001) increased lipid levels. Decreases in the TC/HDL-C ratio were similar with RPV and EFV. Background N[t] RTI affected RPV-induced lipid changes; all levels increased with zidovudine/lamivudine (3TC) and abacavir/3TC (except triglycerides, which were unchanged). With emtricitabine/tenofovir, levels of HDL-C were increased, TC and LDL-C were unchanged, and triglycerides were decreased. With EFV, lipid levels increased in each N[t]RTI subgroup (except triglycerides were unchanged with abacavir/3TC). Fewer (P < .001) RPV-treated patients than EFV-treated patients had TC, LDL-C, and triglyceride levels above National Cholesterol Education Program cutoffs. More RPV-than EFV-treated patients had HDL-C values below these cutoffs (P = .02). Dyslipidemia AEs were less common with RPV than with EFV. Similar proportions of patients had a ?10% decrease in limb fat (16% with RPV and 17% with EFV). Limb fat was significantly (P < .001) increased to a similar extent (by 12% with RPV and 11% with EFV). At week 96, patients receiving zidovudine/3TC had lost limb fat, and those receiving emtricitabine/tenofovir had gained it. Conclusions. Over the course of 96 weeks, RPV-based therapy was associated with lower increases in lipid parameters and fewer dyslipidemia AEs than EFV-based treatment. Body fat distribution changes were similar between treatments. The N[t]RTI regimen affected lipid and body fat distribution changes. ? The Author 2014.
SDGs
Other Subjects
2',3' dideoxynucleoside derivative; abacavir; anti human immunodeficiency virus agent; benzoxazine derivative; drug combination; efavirenz; lamivudine; lamivudine plus zidovudine; rilpivirine; RNA directed DNA polymerase; RNA directed DNA polymerase inhibitor; tenofovir; zidovudine; adolescent; adult; aged; antagonists and inhibitors; body fat distribution; clinical trial; controlled study; drug combination; drug effects; female; HIV Infections; human; Human immunodeficiency virus 1; male; middle aged; phase 3 clinical trial; photon absorptiometry; randomized controlled trial; very elderly; young adult; Absorptiometry, Photon; Adolescent; Adult; Aged; Aged, 80 and over; Anti-HIV Agents; Benzoxazines; Body Fat Distribution; Dideoxynucleosides; Drug Combinations; Female; HIV Infections; HIV Reverse Transcriptase; HIV-1; Humans; Lamivudine; Male; Middle Aged; Reverse Transcriptase Inhibitors; Rilpivirine; Tenofovir; Young Adult; Zidovudine
Publisher
Oxford University Press
Type
journal article