Llibre Josep M, Domingo Pere, Palacios Rosario, Santos Jesús, Pérez-Elías Maria J, Sánchez-de la Rosa Rainel, Miralles Celia, Antela Antonio, Moreno Santiago
Internal Medicine Department, Hospital de Calella, Barcelona, Spain.
AIDS. 2006 Jun 26;20(10):1407-14. doi: 10.1097/01.aids.0000233574.49220.de.
To describe the 12-month evolution of lipid profile in HIV-infected virologically suppressed patients substituting tenofovir for stavudine.
'Recover' was a prospective, multicenter, switch study conducted at 120 HIV units across Spain designed to identify single nucleoside analogue substitution due to adverse events in real practice. Tenofovir substituted stavudine in 873 adult patients. No other substitutions were allowed. This lipid sub-study included 352 randomly recruited patients with complete follow-up and lipid parameters.
Changes in fasting levels of total cholesterol (TC), high and low-density lipoprotein cholesterol (HDL-C and LDL-C), and triglycerides (TG) at 48 weeks, and their cardiovascular risk (CVR) translation.
At 48 weeks, there was a sustained reduction in median TC (-17.5 mg/dl; P < 0.001), LDL-C (-8.1 mg/dl; P < 0.001), and TG (-35 mg/dl; P < 0.001). HDL-C remained roughly unchanged (-0.8 mg/dl). Patients with baseline hyperlipidaemia showed greater reductions in LDL-C (-29 mg/dl; P < 0.001) and TG (-76 mg/dl; P < 0.001). The greatest TG reduction was observed in patients with severe hyper-TG (-266 mg/dl; P < 0.001). The estimated 10-year CVR decreased in all patients (P < 0.001), and to a higher extent in patients with baseline hyperlipidaemia. There was a trend towards reduction according to the use of lipid-lowering agents (11.6% to 9,9%; P = non-significant).
The substitution of tenofovir for stavudine causes a sustained improvement of dyslipidaemia. The reduction, although modest, is robust and sustained over time, and significantly reduces the CVR. This switch strategy is safe and contributes to an improvement in the lipid profile, especially TG, in HAART-treated patients.
描述在病毒学抑制的HIV感染患者中用替诺福韦替代司他夫定后12个月血脂谱的变化情况。
“恢复”研究是一项在西班牙120个HIV治疗单位开展的前瞻性、多中心、换药研究，旨在确定实际临床中因不良事件导致的单核苷类似物替换情况。873例成年患者用替诺福韦替代了司他夫定。不允许进行其他替换。这项血脂亚研究纳入了352例随机招募的有完整随访资料和血脂参数的患者。
48周时总胆固醇（TC）、高密度和低密度脂蛋白胆固醇（HDL-C和LDL-C）以及甘油三酯（TG）空腹水平的变化，及其心血管风险（CVR）转换情况。
48周时，TC中位数持续下降（-17.5mg/dl；P<0.001），LDL-C下降（-8.1mg/dl；P<0.001），TG下降（-35mg/dl；P<0.001）。HDL-C大致保持不变（-0.8mg/dl）。基线血脂异常患者的LDL-C（-29mg/dl；P<0.001）和TG（-76mg/dl；P<0.001）下降幅度更大。严重高TG患者的TG下降幅度最大（-266mg/dl；P<0.001）。所有患者的估计10年CVR均下降（P<0.001），基线血脂异常患者下降幅度更大。根据降脂药物的使用情况有下降趋势（11.6%至9.9%；P=无显著性差异）。
用替诺福韦替代司他夫定可使血脂异常持续改善。这种下降幅度虽小，但随着时间推移是稳定且持续的，并显著降低了CVR。这种换药策略是安全的，有助于改善接受高效抗逆转录病毒治疗（HAART）患者的血脂谱，尤其是TG。
