Endothelial function in HIV-infected patients switching from a boosted protease inhibitor-based regimen to raltegravir: a substudy of the SPIRAL study
Endothelial function in HIV-infected patients switching from a boosted protease inhibitor-based regimen to raltegravir: a substudy of the SPIRAL study
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DOI：
10.1093/jac/dks412
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发表时间：
2013-02-01
影响因子：
5.2
通讯作者：
Gutierrez, Felix
中科院分区：
文献类型：
--
作者：
Masia, Mar;Martinez, Esteban;Gutierrez, Felix
已证明雷特格韦对几种代谢参数具有有利影响，包括脂质和葡萄糖浓度无变化。我们的目的是评估从利托那韦增强的蛋白酶抑制剂（PI/r）为基础的方案转换为雷特格韦对内皮功能的影响，这是SPIRAL研究的一个子研究，SPIRAL研究是一项多中心、随机、开放标签的临床试验，包括HIV感染患者接受稳定的PI/r为基础的抗逆转录病毒方案，病毒学抑制至少6个月。通过肱动脉血流介导的扩张（FMD）在基线和第24周和第48周前瞻性评估内皮功能。35例HIV感染患者被纳入。16例患者被随机分配继续目前的PI/r方案，19例将PI/r转换为雷特格韦。总胆固醇、低密度脂蛋白胆固醇和甘油三酯在第16周和第32周时在雷特格韦转换组中降低，而在PI/r组中未观察到变化。在第16周、第32周和第48周时，雷特格韦组的甘油三酯水平显著低于PI/r组。第24周和第48周，雷特格韦和PI/r组内或组间FMD较基线无显著变化。调整基线动脉直径对FMD差异无显著影响。在病毒学抑制的患者中，从基于PI/r的抗逆转录病毒方案转换为雷特格韦对血脂谱有有益影响，但在1年随访后，似乎对内皮功能没有明显影响。
Raltegravir has been demonstrated to have a favourable impact on several metabolic parameters, including a lack of changes in lipid and glucose concentrations. We aimed to assess the effect on endothelial function of switching from a ritonavir-boosted protease inhibitor (PI/r)-based regimen to raltegravir.This is a substudy of the SPIRAL study, a multicentre, randomized, open-label clinical trial including HIV-infected patients on a stable PI/r-based antiretroviral regimen and virologically suppressed for at least the previous 6 months. Endothelial function was prospectively evaluated through flow-mediated dilatation (FMD) of the brachial artery at baseline and at weeks 24 and 48.Thirty-five HIV-infected patients were included. Sixteen patients were randomly assigned to continue their current PI/r regimen and 19 to switch the PI/r to raltegravir. Total cholesterol, low-density lipoprotein cholesterol and triglycerides decreased at weeks 16 and 32 in the raltegravir-switch arm, while no changes were observed in the PI/r arm. Triglyceride levels were significantly lower in the raltegravir arm than in the PI/r arm at weeks 16, 32 and 48. No significant changes from baseline occurred in FMD at weeks 24 and 48 within or between the raltegravir and PI/r arms. Adjustment for baseline artery diameter did not have a significant effect on the FMD differences.Switching from a PI/r-based antiretroviral regimen to raltegravir in patients with virological suppression has a beneficial impact on the lipid profile, but it does not seem to have a clear impact on endothelial function after a 1 year follow-up.