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Response to Cholesterol-Lowering Drugs in Patients With and Without HIV Infection FREE

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The summary below is from the full report titled “Response to Newly Prescribed Lipid-Lowering Therapy in Patients With and Without HIV Infection.” It is in the 3 March 2009 issue of Annals of Internal Medicine (volume 150, pages 301-313). The authors are M.J. Silverberg, W. Leyden, L. Hurley, A.S. Go, C.P. Quesenberry Jr., D. Klein, and M.A. Horberg.

Ann Intern Med. 2009;150(5):I-38. doi:10.7326/0003-4819-150-5-200903030-00003
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What is the problem and what is known about it so far?

Human immunodeficiency virus (HIV) causes AIDS. The body's ability to fight off infections and certain types of cancer. Treatments, especially those that include protease inhibitors or non-nucleoside reverse transcriptase inhibitors (NNRTIs), have greatly improved outcomes for patients with HIV infection. Cholesterol problems can be side effects of HIV treatments. We do not know whether cholesterol problems are harder to treat in HIV-infected patients than in uninfected patients.

Why did the researchers do this particular study?

To compare the effectiveness and side effects of drugs to treat cholesterol problems in patients with and without HIV infection.

Who was studied?

829 patients with HIV infection and 6941 patients without HIV infection.

How was the study done?

The researchers compared changes in patients' levels of low-density lipoprotein (LDL) cholesterol (bad cholesterol) and triglycerides (another bad fat) after the start of cholesterol treatment. They also looked at whether the cholesterol changes in HIV-infected patients were related to the types of HIV treatments that they were taking.

What did the researchers find?

Patients with HIV infection who started cholesterol treatments had smaller changes in LDL cholesterol than patients without HIV infection; this did not vary with type of HIV treatment. High triglyceride levels were more difficult to treat in HIV-infected patients than in uninfected patients, and the difficulty varied with the type of HIV treatment. Patients receiving regimens containing both protease inhibitors and NNRTIs had the smallest changes in triglyceride levels, followed by patients receiving protease inhibitors only. However, HIV-infected patients who were receiving NNRTIs only and the cholesterol-lowering drug gemfibrozil had decreases in triglyceride levels similar to those in uninfected patients receiving gemfibrozil. Side effects of cholesterol treatments occurred in very few patients, but HIV-infected patients had more changes in liver and muscle enzyme levels than uninfected patients.

What were the limitations of the study?

This study included only patients with health insurance, most of the patients were men, and not all patients had cholesterol measured at the same time points.

What are the implications of the study?

Cholesterol problems seem to be more difficult to treat in HIV-infected patients than in uninfected patients. The benefits in terms of LDL cholesterol and triglyceride levels are smaller in HIV-infected patients than in uninfected patients receiving the same drugs. Gemfibrozil seems to be a good choice for treating high triglyceride levels in HIV-infected patients who are taking NNRTIs. Side effects of cholesterol treatments occur in very few patients.





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