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Titolo:
Antiretroviral treatment simplification with nevirapine in protease inhibitor-experienced patients with HIV-associated lipodystrophy
Autore:
Ruiz, L; Negredo, E; Domingo, P; Paredes, R; Francia, E; Balague, M; Gel, S; Bonjoch, A; Fumaz, CR; Johnston, S; Romeu, J; Lange, J; Clotet, B;
Indirizzi:
Hosp Univ Germans Trias & Pujol, Retrovirol Lab, IrsiCaixa Fdn, Barcelona 08916, Spain Hosp Univ Germans Trias & Pujol Barcelona Spain 08916 elona 08916, Spain Hosp Univ Germans Trias & Pujol, HIV Unit, Barcelona 08916, Spain Hosp Univ Germans Trias & Pujol Barcelona Spain 08916 elona 08916, Spain Univ Autonoma Barcelona, Hosp Santa Cruz & San Pablo, Med Interna Serv, E-08193 Barcelona, Spain Univ Autonoma Barcelona Barcelona Spain E-08193 E-08193 Barcelona, Spain Univ Amsterdam, Dept Internal Med, Amsterdam, Netherlands Univ Amsterdam Amsterdam Netherlands ternal Med, Amsterdam, Netherlands Univ Amsterdam, Natl AIDS Therapy Evaluat Ctr, Amsterdam, Netherlands UnivAmsterdam Amsterdam Netherlands valuat Ctr, Amsterdam, Netherlands
Titolo Testata:
JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
fascicolo: 3, volume: 27, anno: 2001,
pagine: 229 - 236
SICI:
1525-4135(20010701)27:3<229:ATSWNI>2.0.ZU;2-F
Fonte:
ISI
Lingua:
ENG
Soggetto:
IMMUNODEFICIENCY-VIRUS TYPE-1; METABOLIC ABNORMALITIES; COMBINATION THERAPY; T-CELLS; INFECTION; PLASMA; MORTALITY; EFFICACY; RNA;
Keywords:
HIV; lipodystrophy; nevirapine; protease inhibitors; treatment simplification;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
29
Recensione:
Indirizzi per estratti:
Indirizzo: Ruiz, L Hosp Univ Germans Trias & Pujol, Retrovirol Lab, IrsiCaixa Fdn, Ctra Canyet S-N, Barcelona 08916, Spain Hosp Univ Germans Trias & Pujol Ctra Canyet S-N Barcelona Spain 08916
Citazione:
L. Ruiz et al., "Antiretroviral treatment simplification with nevirapine in protease inhibitor-experienced patients with HIV-associated lipodystrophy", J ACQ IMM D, 27(3), 2001, pp. 229-236

Abstract

Background: Simpler and less toxic antiretroviral strategies: are needed to maximize treatment compliance without sacrificing potency, at least for drug-experienced HIV-infected patients currently on regimens containing protease inhibitors (PIs). Small nonrandomized studies have suggested a beneficial role of PI-sparing regimens on lipodystrophy. Objectives: To assess the virologic, immunologic, and clinical benefit of switching the PI to nevirapine in patients: with HIV-associated lipodystrophy and sustained viral suppression before entry in the study. Design: Open-labeled, prospective, randomized, multicenter study. Setting: Seven reference inpatient centers for HIV/AIDS in Spain. Patients: One hundred six HIV-infected adults with clinically evident lipodystrophy who sustained HIV-RNA suppression for at least 6 months with PI-containing antiretroviral combinations. Intervention: Replacement of the PI with nevirapine during 48 weeks (GroupA) versus continuing the prior PI (Group B). Measurements: Several virologic and immunologic analyses, standard and specific biochemical tests, and anthropometric and dual X-ray absorptiometry measurements. Results: At week 48, an HIV-I RNA level < 400 copies/ml was maintained in 79% and 77% of patients in Groups A and B, respectively, whereas 74% and 72% of patients had viral load levels < 50 copies/ml. Absolute CD4(+) counts significantly increased in both groups compared with baseline values, and asignificant decrease in CD38(+)CD8(+) cells was observed ill Group A (p < .01) but not in group B. Overall, no significant changes in anthropometric or body shape measurements were found after 48 weeks. Fasting total cholesterol and triglyceride levels decreased in Group A (but not in Group B) compared with baseline values (p < .05), although no significant differences were seen between groups at the end of the study. Subjects in Group A reported a better quality of life (QOL) index than controls (p < .001), with the main reason reported being the greater simplicity of the new drug regimen. Conclusions: Protease inhibitor-sparing regimens, including nevirapine, seem to be an effective alternative for PI-experienced patients. Nevirapine-based triple therapies allow maintained control of HIV-I RNA levels and improve the immunologic response at 48 weeks of follow-up in patients with prior sustained virologic suppression. The switch to nevirapine significantly improved the lipidic profile in Group A. although there were no differences between groups at the end of the study. Additionally, no significant changes were seen in terms of lipodystrophy-related body shape changes 1 year after the PI substitution. Finally, nevirapine-containing regimens have a simpler dosing schedule, and this facilitates high adherence and improves QOL.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 20/01/20 alle ore 10:18:42