Close ART patient monitoring urged

Friday 11th May 2007

Close monitoring of patients on different antiretroviral therapy (ART) strategies is necessary due to differential effects on lipid metabolism and overall increases in insulin and insulin resistance, a study has concluded.

The investigation assessed metabolic-parameter and body-composition changes among 422 antiretroviral-naïve patients randomised to three ART regimens: protease inhibitor (PI; n=141); non-nucleoside reverse transcriptase inhibitor (NNRTI; n=141); and PI + NNRTI (n=140).

At baseline and one-month (metabolic parameters only) and four-month follow-up intervals, fat-free mass (FFM) and total body fat were calculated, anthropometric measurements were performed and fasting metabolic parameters were obtained. Patients were followed up for a median of five years.

The investigators reported that:

• PI + NNRTI resulted in greater increases in triglycerides and LDL cholesterol compared with the PI- and NNRTI-alone strategies (p<0.005), with no differences between the latter two strategies.

• HDL cholesterol increased more in the NNRTI- than the PI-only arm (p<0.005).

• Insulin and insulin resistance increased similarly in all three arms.

• Changes in total and regional body composition (loss of subcutaneous tissue area and gains in FFM, nonsubcutaneous tissue area, and visceral tissue area) were observed but did not differ by treatment group.

J Acquir Immune Defic Syndr 2007;44:506-17