Fisac Cesar, Fumero Emilio, Crespo Manuel, Roson Beatriz, Ferrer Elena, Virgili Nuria, Ribera Esteban, Gatell Jose Maria, Podzamczer Daniel
Nutrition Section, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
AIDS. 2005 Jun 10;19(9):917-25. doi: 10.1097/01.aids.0000171405.46113.bf.
To evaluate the 24-month metabolic and morphological benefits obtained from replacing the protease inhibitor (PI) in a regimen with nevirapine, efavirenz or abacavir.
NEFA was a randomized study designed to compare the efficacy of nevirapine, efavirenz or abacavir as substitutes for PI. A subset of 90 patients [abacavir (n = 29), efavirenz (n = 32), nevirapine (n = 29)] formed the metabolic study. Fasting total cholesterol (TC), high density lipoprotein cholesterol (HDL-c) and triglycerides levels were determined. Glucose homeostasis parameters were also collected. Lipodystrophy was evaluated by clinical examination and morphological measurements.
Treatment simplification led to overall lipid profile improvements. At 24 months, the two non-nucleoside reverse transcriptase inhibitors produced similar lipid benefits: HDL-c levels increased [efavirenz, 15% (P = 0.001); nevirapine, 21% (P < 0.001)] and TC to HDL-c ratios decreased [efavirenz, 14% (P < 0.001); nevirapine, 19% (P < 0.01)], an effect not observed in the abacavir arm. Non-HDL-c levels decreased by 10% in both the abacavir (P = 0.001) and efavirenz (P < 0.05) arms. Significant decreases in the levels of triglycerides occurred for the first year in all treatments; however, at 24 months most of the initial loss had been regained. Patients with baseline moderate or severe lipodystrophy obtained less-pronounced lipid benefits. Several insulin resistance markers showed a trend towards improvement. Conversely, no improvements in morphological abnormalities were observed.
Replacing PI with efavirenz, nevirapine or abacavir improved the lipid profile, with more marked results in non-lipodystrophic patients. In contrast, this strategy does not seem to be effective for reversing body fat abnormalities.
评估用奈韦拉平、依非韦伦或阿巴卡韦替换治疗方案中的蛋白酶抑制剂（PI）所获得的24个月代谢和形态学益处。
NEFA是一项随机研究，旨在比较奈韦拉平、依非韦伦或阿巴卡韦作为PI替代品的疗效。90名患者的一个亚组[阿巴卡韦（n = 29）、依非韦伦（n = 32）、奈韦拉平（n = 29）]构成了代谢研究对象。测定空腹总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-c）和甘油三酯水平。还收集了葡萄糖稳态参数。通过临床检查和形态学测量评估脂肪营养不良。
治疗简化导致总体血脂状况改善。在24个月时，两种非核苷类逆转录酶抑制剂产生了相似的血脂益处：HDL-c水平升高[依非韦伦，15%（P = 0.001）；奈韦拉平，21%（P < 0.001）]，TC与HDL-c比值降低[依非韦伦，14%（P < 0.001）；奈韦拉平，19%（P < 0.01）]，阿巴卡韦组未观察到这种效果。阿巴卡韦组（P = 0.001）和依非韦伦组（P < 0.05）的非HDL-c水平均下降了10%。在所有治疗的第一年，甘油三酯水平均显著下降；然而，在24个月时，大部分最初的下降幅度已恢复。基线时患有中度或重度脂肪营养不良的患者获得的血脂益处不太明显。几个胰岛素抵抗标志物显示出改善趋势。相反，未观察到形态学异常有所改善。
用依非韦伦、奈韦拉平或阿巴卡韦替换PI可改善血脂状况，在非脂肪营养不良患者中效果更显著。相比之下，这种策略似乎对逆转身体脂肪异常无效。
