AEGiS-ATN: Successful Standard Treatment for Lipid Abnormalities: Experience with 44 Patients

Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.

Successful Standard Treatment for Lipid Abnormalities: Experience with 44 Patients

AIDS TREATMENT NEWS Issue #304, October 2, 1998
John S. James

On September 26 THE LANCET published a research letter on a study at Regions Hospital in St. Paul, Minnesota on the treatment of abnormal cholesterol and triglyceride levels in persons receiving HIV protease inhibitors(1); the same team had published an early report of coronary artery disease associated with protease inhibitors(2) (see "Metabolic Changes: Concerns About Heart, Circulatory Risks," AIDS TREATMENT NEWS #295, May 15, 1998). Patients who volunteered for this study were treated according to the guidelines of the National Cholesterol Education Program (NCEP), under the care of a lipid specialist. All of them continued to receive protease inhibitors.

Twenty patients with milder lipid abnormalities were first treated with diet and exercise alone; 12 of the 20 were judged to be treatment failures and started on lipid-lowering drugs (gemfibrozil and/or atorvastatin). Of the patients who were treated with both of these drugs and who had the highest lipid levels, cholesterol was reduced by 30%, and triglycerides by 60%, over six months; a table in the article gives the actual values for the different treatment groups. The investigators believe it is likely that these changes indicate a significantly reduced risk of heart disease.

The paper also noted that patients in their clinic who were receiving ritonavir and saquinavir were more likely to have lipid abnormalities than those on other protease inhibitors.

"The NCEP guidelines advise caution in use of gemfibrozil and statins together due to a concern about increased risk for myopathy. In addition, there is concern about an increased risk for toxicity when atorvastatin is used in combination with drugs that interfere with the cytochrome p450 metabolic pathway in the liver (such as protease inhibitors). We saw no instances of myopathy, raised creatine kinase of liver enzymes, or adverse virological events among these patients."

The authors conclude that "our preliminary data suggest that management of raised lipids associated with protease inhibitors can be done carefully following NCEP guidelines."

References

1. Henry K, Melroe H, Huebesch J, Hermundson J, and Simpson J. Atorvastatin and gemfibrozil for protease-inhibitor- related lipid abnormalities. THE LANCET. September 26, 1998; volume 352, number 3133, pages 1031-1032.

2. Henry K, Melroe H, Huebesch J, and others. Severe premature coronary artery disease with protease inhibitors. THE LANCET. May 2, 1998; volume 351, page 1328.

981002
ATN30404

Copyright © 1998 - AIDS Treatment News. Permission granted for noncommercial reproduction, provided that our address and phone number are included if more than short quotations are used. Subscription lists are kept confidential. AIDS Treatment News, Subscription and Editorial Office: 1233 Locust St., 5th floor Philadelphia, PA 19107 800/TREAT-1-2 toll-free email: aidsnews@critpath.org http://www.aidsnews.org

Subscription Information: Call 800/TREAT-1-2: Businesses, Institutions, Professionals: $270/year. Includes early delivery of an extra copy by email. Nonprofit organizations: $135/year. Includes early delivery of an extra copy by email. Individuals: $120/year, or $70 for six months. Special discount for persons with financial difficulties: $54/year, or $30 for six months. If you cannot afford a subscription, please write or call. Outside North, Central, or South America, add air mail postage: $20/year, $10 for six months. Back issues available. Fax subscriptions, bulk rates, and multiple subscriptions are available; contact our office for details. Please send U.S. funds: personal check or bank draft, international postal money order, or travelers checks. VISA, Mastercard, and purchase orders also accepted. ISSN # 1052-4207

AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 1998. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 1998. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .