Impact of Switching from Human Immunodeficiency Virus Type 1 Protease Inhibitors to Efavirenz in Successfully Treated Adults with Lipodystrophy

Abstract

We prospectively followed 20 consecutive patients with human immunodeficiency virus type 1 (HIV-1) with viral loads of + cells, and viral load. At baseline, hypertriglyceridemia (⩾200 mg/dL) was present in 17 (85%) patients, hypercholesterolemia (⩾200 mg/dL) in 14 (70%), and impaired fasting glucose (⩾110 mg/dL) in 8 (40%); CD4⁺ T cells were 280 × 10⁶ cells/L (range, 64–942 × 10⁶ cells/L). HIV-1 RNA had been at P = .03) and fasting insulin resistance index (a decrease of 28%; P = .03), but total and high-density lipoprotein cholesterol and glucose did not change. Waist-to-hip ratio decreased from 0.92 to 0.87 (P = .06). Subcutaneous fat thickness did not change. CD4⁺ cells remained stable (363 × 10⁶ cells/L; range, 102–741 × 10⁶ cells/L; P = .65). Nineteen patients (95%) had HIV-1 RNA levels that remained at + response and viral suppression remained preserved after 6 months of switching from protease inhibitor to efavirenz, the benefits of this approach on the evolution of lipodystrophy were limited, and our findings do not support its routine recommendation to treat lipodystrophy.