Lipid profile changes associated with antiretroviral therapies in a real-world cohort

by Selleckchem | Oct 21 2023

Objective: To compare lipid profile changes and cardiovascular events among HIV naïve and experienced patients from a real-world cohort treated with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate or dolutegravir/abacavir/lamivudine.

Method: A retrospective cohort study in HIV naïve and experienced people at a reference hospital in Spain was done. During the follow-up (March 2015-June 2019), patients were treated with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate or dolutegravir/abacavir/lamivudine. Epidemiological, clinical, and immunovirological variables were recorded. A statistical analysis of the lipid profile at baseline, 48, and 120 weeks after initiating the study therapy, cardiovascular events (myocardial infarction, heart failure, cerebrovascular accident, deep venous thrombosis, myocardiopathy, non-ST-segment elevation acute coronary syndrome, and ST-segment elevation myocardial infarction), and cardiovascular risks factors was performed. Data were analysed in naïve and experienced patients from each of the study treatments. The data were obtained from the medical history. The statistical analysis was performed with SPSS v. 24 software.

Results: A total of 266 and 191 patients receiving treatment with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate and dolutegravir/abacavir/lamivudine were included in the study, respectively. After 120 weeks of treatment, a worsening of the lipid profile was found in the elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate group, both in naïve and experienced patients, whereas not so conspicuously observed in the dolutegravir/abacavir/lamivudine group. Statistically significant differences between both groups were found in experienced patients favouring dolutegravir/abacavir/lamivudine; in total cholesterol (204.1±38.2 vs. 187.3±29.4, P < .001) and LDL-C (126.1±31.9 vs. 113.5±28.5, P = .001) at week 48, and in total cholesterol (201.1±33.4 vs. 188.7±33.9, P = .013) and HDL-C (54.2±15.6 vs. 48.3±14.3, P = .01) at week 120. No significant differences in cardiovascular events were found, neither in naïve nor in experienced patients.

Conclusions: The lipid profile among elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate group worsened throughout the follow-up, both in naïve and experienced patients, not so remarkable in the dolutegravir/abacavir/lamivudine group. Both regimens were well tolerated, with similar rates of cardiovascular events.

Comments:

Summary of the Study: The objective of the study was to compare changes in lipid profiles and cardiovascular events between HIV-naïve and experienced patients treated with two different antiretroviral therapy regimens: elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate and dolutegravir/abacavir/lamivudine. The study was conducted as a retrospective cohort study at a reference hospital in Spain, and data was collected from March 2015 to June 2019.

A total of 266 patients receiving elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate and 191 patients receiving dolutegravir/abacavir/lamivudine were included in the study. The lipid profiles were measured at baseline, 48 weeks, and 120 weeks after starting the treatment. The occurrence of cardiovascular events, including myocardial infarction, heart failure, cerebrovascular accident, deep venous thrombosis, myocardiopathy, non-ST-segment elevation acute coronary syndrome, and ST-segment elevation myocardial infarction, was also recorded.

The results showed that after 120 weeks of treatment, the lipid profile worsened in the elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate group, both in naïve and experienced patients. In contrast, the worsening of the lipid profile was less pronounced in the dolutegravir/abacavir/lamivudine group. Statistically significant differences were found between the two groups of experienced patients, favoring dolutegravir/abacavir/lamivudine, in terms of total cholesterol and LDL-C levels at week 48, as well as total cholesterol and HDL-C levels at week 120.

However, no significant differences in cardiovascular events were observed between the two treatment groups, neither in naïve nor experienced patients.

Conclusions: The study concluded that the elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate regimen was associated with a worsening of the lipid profile over time, while the dolutegravir/abacavir/lamivudine regimen showed a less pronounced effect. However, both regimens were well tolerated and had similar rates of cardiovascular events.