Switch to etravirine for HIV-positive patients receiving statin treatment: a prospective study

Ciaffi, Laura; Cavassini, Matthias; Genne, Daniel; Delhumeau, Cecile; Spycher Elbes, Rachel; Hill, Andrew; Wandeler, Gilles; Fehr, Jan; Stoeckle, Marcel; Schmid, Patrick; Hirschel, Bernard; Montecucco, Fabrizio; Calmy, Alexandra (2015). Switch to etravirine for HIV-positive patients receiving statin treatment: a prospective study. European journal of clinical investigation EJCI, 45(7), pp. 720-730. Wiley-Blackwell 10.1111/eci.12464

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BACKGROUND

Life style changes and statins are the cornerstones in management of dyslipidemia in HIV-infected patients. Replacement of an antiretroviral therapy (ART) component is a proposed therapeutic strategy to reduce cardiovascular risk. In dyslipidemic HIV-positive patients, we assessed the efficacy of replacing boosted protease inhibitor (bPI) or efavirenz (EFV) by etravirine (ETR) as an alternative to statin therapy.

MATERIALS AND METHODS

A prospective, open-label, multicentre, 12-week study of HIV-infected patients on ART including bPI or EFV, and statin treatment. Four weeks after statin interruption, bPI or EFV were switched to ETR (400 mg, 8 weeks) if serum low-density lipoprotein cholesterol (LDL-c) was ≥ 3 mmol/L. The primary endpoint was the proportion of patients on ETR with no indication for statin treatment at study completion. Serum levels of HIV-RNA, lipids, and biomarkers of cardiovascular disease were also measured. (ClinicalTrialsgov: NCT01543035).

RESULTS

The 31 included patients had a HIV1-RNA <50 copies/mL (median age, 52 years; median CD4, 709 cell/mL; median LDL-c, 2.89 mmol/L), 68% were on EFV, 32% on bPI. At week 4, 27 patients switched to ETR. At study completion, 15 patients (56%) on ETR did not qualify for statin treatment. After the ETR switch, serum levels of the cardiovascular biomarkers sICAM and MCP1/CCL2 decreased by 11.2% and 18.9%, respectively, and those of CCL5/RANTES and tissue inhibitor of metalloproteinase-1 increased by 14.3% and 13.4%, respectively, indicating reduced cardiovascular risk. There were no notable treatment-related adverse events.

CONCLUSIONS

Replacing bPI or EFV by ETR is a viable strategy to obviate primary prevention statin treatment. This article is protected by copyright. All rights reserved.

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