National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney 2052, New South Wales, Australia.
J Antimicrob Chemother. 2010 Sep;65(9):1878-88. doi: 10.1093/jac/dkq231. Epub 2010 Jun 16.
To compare lipid profiles in HIV-infected adults receiving atazanavir-based regimens.
We conducted a systematic review of randomized controlled trials (RCTs) comparing atazanavir or atazanavir/ritonavir with a comparator and evaluated lipids at 48 weeks. We searched MEDLINE, EMBASE, CENTRAL, LILACS, Current Controlled Trials, National Institutes of Health Clinical Trials Registry, trials at AIDSinfo and HIV conference proceedings to May 2009. Standardized mean difference (SMD) between study arms in change from baseline to week 48 in lipid parameters was determined weighted by study size and 95% confidence intervals (CI) were calculated.
Nine eligible RCTs were identified (n = 3346). SMDs (mmol/L) in four RCTs comparing atazanavir/ritonavir with a ritonavir-boosted protease inhibitor were: total cholesterol, -0.62 (95% CI -0.72, -0.51); low-density lipoprotein (LDL) cholesterol, -0.31 (95% CI -0.44, -0.17); high-density lipoprotein (HDL) cholesterol, -0.16 (95% CI -0.27, -0.06); non-HDL cholesterol, -0.58 (95% CI -0.69, -0.48); and triglycerides, -0.46 (95% CI -0.58, -0.34). Atazanavir compared with non-atazanavir (three RCTs) found lower total, LDL and non-HDL cholesterol, and triglycerides [SMD -0.87 mmol/L (95% CI -0.99, -0.76); -0.56 mmol/L (95% CI -0.67, -0.45); -0.88 mmol/L (95% CI -0.99, -0.76); and -0.56 mmol/L (95% CI -0.75, -0.36), respectively], but HDL cholesterol did not differ [-0.16 mmol/L (95% CI -0.49, 0.16)]. In the atazanavir/ritonavir versus atazanavir comparison (two RCTs), total [SMD 0.44 mmol/L (95% CI 0.23, 0.65)] and non-HDL cholesterol [SMD 0.44 mmol/L (95% CI 0.23, 0.65)] were higher, but HDL cholesterol, LDL cholesterol and triglycerides were not different.
At 48 weeks, plasma lipid concentrations were lower with atazanavir/ritonavir than with other ritonavir-boosted protease inhibitor regimens. Total and non-HDL cholesterol were higher with atazanavir/ritonavir than atazanavir alone.
比较接受阿扎那韦为基础方案治疗的 HIV 感染成人的血脂谱。
我们对比较阿扎那韦或阿扎那韦/利托那韦与对照药物的随机对照试验（RCT）进行了系统评价，并评估了第 48 周的血脂情况。我们检索了 MEDLINE、EMBASE、CENTRAL、LILACS、临床试验注册处的当前对照试验、美国国立卫生研究院临床试验注册处、AIDSinfo 和 HIV 会议记录，检索时间截至 2009 年 5 月。根据研究规模对研究臂之间从基线到第 48 周的脂质参数变化的标准化均数差（SMD）进行了确定，并计算了 95%置信区间（CI）。
确定了 9 项合格的 RCT（n = 3346）。与利托那韦增强蛋白酶抑制剂相比，阿扎那韦/利托那韦的四项 RCT 比较的 SMD（mmol/L）为：总胆固醇，-0.62（95%CI -0.72，-0.51）；低密度脂蛋白（LDL）胆固醇，-0.31（95%CI -0.44，-0.17）；高密度脂蛋白（HDL）胆固醇，-0.16（95%CI -0.27，-0.06）；非高密度脂蛋白胆固醇，-0.58（95%CI -0.69，-0.48）；和甘油三酯，-0.46（95%CI -0.58，-0.34）。与非阿扎那韦（三项 RCT）相比，阿扎那韦发现总胆固醇、LDL 胆固醇和非高密度脂蛋白胆固醇以及甘油三酯水平更低[SMD -0.87 mmol/L（95%CI -0.99，-0.76）；-0.56 mmol/L（95%CI -0.67，-0.45）；-0.88 mmol/L（95%CI -0.99，-0.76）和-0.56 mmol/L（95%CI -0.75，-0.36）]，但高密度脂蛋白胆固醇无差异[-0.16 mmol/L（95%CI -0.49，0.16）]。在阿扎那韦/利托那韦与阿扎那韦比较的两项 RCT 中，总胆固醇[SMD 0.44 mmol/L（95%CI 0.23，0.65）]和非高密度脂蛋白胆固醇[SMD 0.44 mmol/L（95%CI 0.23，0.65）]更高，但高密度脂蛋白胆固醇、LDL 胆固醇和甘油三酯没有差异。
48 周时，与其他利托那韦增强蛋白酶抑制剂方案相比，阿扎那韦/利托那韦治疗的患者血浆脂质浓度更低。与阿扎那韦单独治疗相比，阿扎那韦/利托那韦治疗的总胆固醇和非高密度脂蛋白胆固醇更高。
