A comparison of the effects of nevirapine and nelfinavir on metabolism and body habitus in antiretroviral-naive human immunodeficiency virus-infected patients: a randomized controlled study.
A comparison of the effects of nevirapine and nelfinavir on metabolism and body habitus in antiretroviral-naive human immunodeficiency virus-infected patients: a randomized controlled study.
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DOI：
10.1210/jc.2002-021830
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发表时间：
2003-11
期刊：
影响因子：
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通讯作者：
C. Fisac;N. Virgili;E. Ferrer;M. Barberá;E. Fumero;C. Vilarasau;D. Podzamczer
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文献类型：
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作者：
C. Fisac;N. Virgili;E. Ferrer;M. Barberá;E. Fumero;C. Vilarasau;D. Podzamczer
新的HIV治疗显著提高了生存率，但与多种代谢变化有关，其中大多数与蛋白酶抑制剂（PI）有关。本研究的目的是阐明和比较接受两种核苷类药物加PI奈非那韦（NFV）或非核苷类逆转录酶抑制剂奈韦拉平（NVP）的HIV感染抗逆转录病毒初治患者的形态学和代谢改变。分析了43例接受6-12个月治疗的患者（NFV，n = 20; NVP，n = 23）。通过生物电阻抗分析、标准人体测量学和临床检查评估形态学变化。测定血清总胆固醇（TC）、低密度和高密度（HDL-c）脂蛋白胆固醇、甘油三酯、葡萄糖和胰岛素以及其他代谢参数。未观察到组间基线差异。两组的TC均升高（NVP，11%; NFV，17%）。两组的HDL-c也升高，但在接受NVP的患者中更明显（44% vs. 20%）;治疗水平也升高（1.57 vs. 1.28 mmol/L）。由于这些变化，NVP组的TC/HDL-c比值下降了22%，NFV组保持稳定。随着NFV的使用，TC/HDL-c比值和伴随的心血管风险没有改变。相比之下，NVP在血脂状态方面提供了益处，表现为HDL-c浓度升高和TC/HDL-c比值降低。在决定冠状动脉高风险患者的抗逆转录病毒治疗方案时，应考虑纳入NVP。
New HIV therapies have significantly increased survival, but are associated with multiple metabolic changes, most of them related to the protease inhibitors (PIs). The objective of this study was to elucidate and compare morphological and metabolic alterations in HIV-infected antiretroviral-naive patients receiving two nucleosides plus the PI nelfinavir (NFV) or the nonnucleoside reverse transcriptase inhibitor nevirapine (NVP). Forty-three patients (NFV, n = 20; NVP, n = 23) receiving 6-12 months of treatment were analyzed. Morphological changes were evaluated by bioelectrical impedance analysis, standard anthropometrics, and clinical examination. Serum total cholesterol (TC), low-density and high- density (HDL-c) lipoprotein cholesterol, triglycerides, glucose, and insulin were determined, among other metabolic parameters. No baseline differences were observed between groups. TC increased in both arms (NVP, 11%; NFV, 17%). HDL-c also increased in both groups, although more markedly in those receiving NVP (44% vs. 20%); on-treatment levels were also elevated (1.57 vs. 1.28 mmol/liter). As a consequence of these changes, the TC/HDL-c ratio dropped by 22% in the NVP arm and remained stable in the NFV group. With the use of NFV, the TC/HDL-c ratio and attendant cardiovascular risk did not change. In contrast, NVP offered benefits regarding lipid status, as manifested by enhanced HDL-c concentrations and decreased TC/HDL-c ratios. Inclusion of NVP should be considered when deciding upon antiretroviral regimens for patients at high coronary risk.