Saumoy Maria, Tiraboschi Juan M, Ordoñez-Llanos Jordi, Ribera Esteban, Domingo Pere, Mallolas Josep, Curto Jordi, Gatell Josep M, Podzamczer Daniel
a HIV and STD Unit, Infectious Disease Service , Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL) , L'Hospitalet de Llobregat , Spain.
b Biochemistry Department , Biomedical Research Institute IIB Sant Pau , Barcelona , Spain.
HIV Clin Trials. 2017 Mar;18(2):49-53. doi: 10.1080/15284336.2016.1275425. Epub 2017 Jan 12.
The objective of this study was to determine the impact of tenofovir or abacavir discontinuation on low-density lipoprotein (LDL) phenotype and lipoprotein-associated phospholipase A2 (Lp-PLA2) activity in HIV-infected patients treated with lopinavir/ritonavir plus 2 nucleos(t)ide reverse transcriptase inhibitors (NRTI).
Multicenter, open-label study. Patients were randomized to continue with lopinavir/ritonavir plus 2 NRTI (triple therapy) or to switch to lopinavir/ritonavir plus lamivudine (dual therapy). LDL phenotype (by gradient gel electrophoresis) and Lp-PLA2 (by 2-thio-PAF) were determined at baseline and week 48.
Forty-four patients included (triple therapy n = 19, dual therapy n = 25): men 63.6%, age 41.5 years (25-61), Framingham score 4.9% (0.2-22). Tenofovir was part of the regimen in 28 (63.6%) patients. Dual therapy patients were younger (p = 0.013) and had lower baseline apolipoprotein A1 (p = 0.029). At week 48, there were no changes in standard lipid measurements, except ApoA1/Apo B, which increased in dual therapy (p = 0.038) with no differences between arms. At week 48, no change in LDL phenotype was found in either arm. No changes in total Lp-PLA2 activity or the relative distribution of LDL and HDL particles were found at week 48 in either arm.
Discontinuing the third nucleos(t)ide, mainly tenofovir and abacavir, in a lopinavir/ritonavir-containing regimen was not associated with a deleterious effect on LDL phenotype nor in Lp-PLA2 activity.
本研究的目的是确定在接受洛匹那韦/利托那韦加2种核苷类逆转录酶抑制剂（NRTI）治疗的HIV感染患者中，停用替诺福韦或阿巴卡韦对低密度脂蛋白（LDL）表型和脂蛋白相关磷脂酶A2（Lp-PLA2）活性的影响。
多中心、开放标签研究。患者被随机分为继续接受洛匹那韦/利托那韦加2种NRTI（三联疗法）或改为接受洛匹那韦/利托那韦加拉米夫定（双联疗法）。在基线和第48周时测定LDL表型（通过梯度凝胶电泳）和Lp-PLA2（通过2-硫代-PAF）。
纳入44例患者（三联疗法组n = 19，双联疗法组n = 25）：男性占63.6%，年龄41.5岁（25 - 61岁），弗雷明汉评分4.9%（0.2 - 22）。28例（63.6%）患者的治疗方案中包含替诺福韦。双联疗法组患者更年轻（p = 0.013）且基线载脂蛋白A1更低（p = 0.029）。在第48周时，除了载脂蛋白A1/载脂蛋白B，标准血脂测量指标无变化，载脂蛋白A1/载脂蛋白B在双联疗法组中升高（p = 0.038），两组间无差异。在第48周时，两组的LDL表型均未发现变化。在第48周时，两组的总Lp-PLA2活性以及LDL和HDL颗粒的相对分布均未发现变化。
在含洛匹那韦/利托那韦的治疗方案中停用第三种核苷类药物，主要是替诺福韦和阿巴卡韦，与对LDL表型或Lp-PLA2活性无有害影响相关。
