Saumoy Maria, Ordoñez-Llanos Jordi, Martínez Esteban, Barragán Patricia, Ribera Esteban, Bonet Rosa, Knobel Hernando, Negredo Eugenia, Loncá Montserrat, Curran Adrian, Gatell Josep Maria, Podzamczer Daniel
Infectious Disease Service, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
Antivir Ther. 2011;16(4):459-68. doi: 10.3851/IMP1785.
The aim of this study was to assess changes in the size and cholesterol content of low-density lipoproteins (LDL) and changes in lipoprotein-associated phospholipase A2 (Lp-PLA2) activity in HIV-infected patients switching to tenofovir + emtricitabine (TDF+FTC) or abacavir + lamivudine (ABC+3TC).
This was a substudy of a multicentre randomized trial comparing TDF+FTC with ABC+3TC-based regimens in patients with virological suppression. Fasting lipids and apolipoproteins (apo), LDL size and cholesterol content and Lp-PLA2 activity were measured at baseline and at week 48.
A total of 62 patients, naive for the compared drugs, were included. At baseline, groups were comparable except for total Lp-PLA2 activity (P=0.047) and for a tendency towards the use of a major baseline thymidine analogue in the TDF+FTC arm (25 versus 18 patients; P=0.054). In the ABC+3TC arm a significant increase in total cholesterol (0.64 mmol/l; P=0.003), high-density lipoprotein cholesterol (HDL-c, 0.13 mmol/l; P=0.031), triglycerides (0.39 mmol/l; P=0.036), apo A-I (0.12 g/l; P=0.006), apo B (0.16 g/l; P=0.015) and non-HDL-c (0.50 mmol/l; P=0.009) concentrations was observed at week 48 compared with the TDF+FTC treatment arm. In addition, an increase in the cholesterol content of small, dense LDL subfractions (0.48 mmol/l; P=0.003) and a decrease in LDL size (-2.6 nm; P=0.011) was observed in the ABC arm without changes in the TDF patients. Total PLA2, LDL-PLA2 and HDL-PLA2 activity decreased in the TDF arm, but multivariate analysis showed baseline PLA2 values and previous use of thymidine analogues as the factors associated with these changes. Estimated cardiovascular risk did not change in either arm.
A more atherogenic LDL profile, including a decrease in LDL size, was found in the ABC group and not in TDF patients.
本研究旨在评估换用替诺福韦+恩曲他滨（TDF+FTC）或阿巴卡韦+拉米夫定（ABC+3TC）的HIV感染患者中低密度脂蛋白（LDL）大小和胆固醇含量的变化以及脂蛋白相关磷脂酶A2（Lp-PLA2）活性的变化。
这是一项多中心随机试验的子研究，在病毒学抑制的患者中比较基于TDF+FTC与基于ABC+3TC的治疗方案。在基线和第48周时测量空腹血脂和载脂蛋白（apo）、LDL大小和胆固醇含量以及Lp-PLA2活性。
共纳入62例对所比较药物初治的患者。在基线时，除总Lp-PLA2活性（P=0.047）以及在TDF+FTC组使用主要基线胸苷类似物的趋势方面（25例对18例患者；P=0.054）外，各组具有可比性。在ABC+3TC组，与TDF+FTC治疗组相比，在第48周时观察到总胆固醇（0.64 mmol/l；P=0.003）、高密度脂蛋白胆固醇（HDL-c，0.13 mmol/l；P=0.031）、甘油三酯（0.39 mmol/l；P=0.036）、apo A-I（0.12 g/l；P=0.006）、apo B（0.16 g/l；P=0.015）和非HDL-c（0.50 mmol/l；P=0.009）浓度显著升高。此外，在ABC组观察到小而密LDL亚组分的胆固醇含量增加（0.48 mmol/l；P=0.003）且LDL大小减小（-2.6 nm；P=0.011），而TDF组患者无变化。TDF组中总PLA2、LDL-PLA2和HDL-PLA2活性降低，但多变量分析显示基线PLA2值和先前使用胸苷类似物是与这些变化相关的因素。两组的估计心血管风险均未改变。
在ABC组中发现LDL谱更具致动脉粥样硬化性，包括LDL大小减小，而TDF组患者未出现此情况。
