March 14th, 2009

Maybe It’s Not the Cheeseburgers

… At least that’s the implied message in this nice paper from the latest Annals of Internal Medicine, which evaluated responses to lipid-lowering therapy among patients with and without HIV.

The study included patients from the Kaiser Permanente of Northern California integrated health system, with 829 individuals with HIV and 6941 without.

The quick summary is that those with HIV responded less well to lipid lowering drugs than the HIV negative patients — something that comes as no surprise to HIV providers, as we’ve scratched our heads for years while various statins, fibrates, and omega-3s have made barely a dent on some pretty scary lipid profiles.

There were a couple of other key take-aways from the paper.  Pravastatin — which just happens to have the fewest drug-drug interactions with HIV drugs — was less effective than other statins.  (Oh well.)  It’s been fairly unanimous among cardiologists I’ve spoken with that they consider pravastatin a fairly wimpy lipid-lowering drug.

In addition, those on boosted PIs had a blunted triglyceride response to gemfibrizol compared to patients on other forms of HIV therapy.  These are, of course, the very people who need triglyceride-lowering the most!

In practice, most patients on a boosted PI are on it for a reason — resistance, contraindications or intolerance to other drugs — so switching them off of it is rarely straightforward.  (See this cautionary tale from CROI.)  Regardless, we can certainly include “lipid friendly” in our list of desirable attributes for the investigational PK boosters.

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HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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