Comprehensive Care Center, Fort Lauderdale, Florida, USA.
Janssen Infectious Diseases BVBA, Beerse, Belgium.
AIDS Rev. 2015 Jan-Mar;17(1):21-36.
Dyslipidemia and lipodystrophy represent significant healthcare concerns in HIV-infected patients due to their association with diabetes mellitus and increased cardiovascular disease risk. Since the lipid effects of the nonnucleoside reverse transcriptase inhibitors are not well characterized, we systematically summarized the effects of nonnucleoside reverse transcriptase inhibitor treatment on dyslipidemia and lipodystrophy in HIV-1 infection. As with other classes of antiretroviral agents, the nonnucleoside reverse transcriptase inhibitors are associated with lipid changes, although individual agents exhibit differing effects on lipid profiles. Comparative trials have shown that the risk for hypertriglyceridemia is lower with efavirenz than with the use of ritonavir-boosted lopinavir, but there is a greater likelihood of hypercholesterolemia compared to ritonavir-boosted atazanavir. Data also suggest that efavirenz results in greater increases in plasma lipid levels than integrase inhibitors and CC-chemokine-receptor-5 antagonists. Lipid disturbances are less frequent with the newer nonnucleoside reverse transcriptase inhibitors than with efavirenz. However, in most cases, no change in the total:high-density lipoprotein-cholesterol ratio was seen between the efavirenz and comparator groups. Switching from efavirenz to etravirine or rilpivirine, or the integrase inhibitors raltegravir or elvitegravir, resulted in significant reductions in lipid levels. There appears to be minimal potential for efavirenz or rilpivirine to result in development of lipodystrophy. Overall, nonnucleoside reverse transcriptase inhibitors have a smaller impact on plasma lipids than ritonavir-boosted protease inhibitors, with the newer agents exhibiting more favorable lipid profiles than efavirenz. When considering antiretroviral regimens, awareness of the different lipid effect profiles of the third agent is important, without forgetting the critical contribution of the background antiretrovirals.
血脂异常和脂肪营养不良是 HIV 感染患者的重要健康问题，因为它们与糖尿病和心血管疾病风险增加有关。由于非核苷类逆转录酶抑制剂的脂质作用尚未得到很好的描述，我们系统地总结了非核苷类逆转录酶抑制剂治疗对 HIV-1 感染患者血脂异常和脂肪营养不良的影响。与其他类别的抗逆转录病毒药物一样，非核苷类逆转录酶抑制剂会引起脂质变化，尽管个别药物对脂质谱的影响不同。比较试验表明，依非韦伦引起的高甘油三酯血症风险低于利托那韦增强洛匹那韦，而与利托那韦增强阿扎那韦相比，高胆固醇血症的可能性更大。数据还表明，依非韦伦导致血浆脂质水平升高的幅度大于整合酶抑制剂和 C 型趋化因子受体 5 拮抗剂。与依非韦伦相比，新型非核苷类逆转录酶抑制剂引起的脂质紊乱较少见。然而，在大多数情况下，依非韦伦组和对照组之间的总胆固醇/高密度脂蛋白胆固醇比值没有变化。从依非韦伦转换为依曲韦林或利匹韦林，或整合酶抑制剂拉替拉韦或艾维雷韦，可显著降低血脂水平。依非韦伦或利匹韦林似乎几乎没有导致脂肪营养不良的潜在风险。总体而言，非核苷类逆转录酶抑制剂对血浆脂质的影响小于利托那韦增强蛋白酶抑制剂，新型药物的脂质谱比依非韦伦更有利。在考虑抗逆转录病毒方案时，需要注意第三个药物的不同脂质效应谱，而不能忘记背景抗逆转录病毒药物的重要贡献。
