Abstract
BackgroundDyslipidaemia and dysglycaemia have been associated with exposure to ritonavir-boosted protease inhibitors. Lopinavir/ritonavir, the most commonly used protease inhibitor in resource-limited settings, often causes dyslipidaemia. There are contradictory data regarding the association between lopinavir concentrations and changes in lipids.AimTo investigate associations between plasma lopinavir concentrations and lipid and glucose concentrations in HIV-infected South African adults.MethodsParticipants stable on lopinavir-based antiretroviral therapy were enrolled into a cross-sectional study. After an overnight fast, total cholesterol, triglycerides, and lopinavir concentrations were measured and an oral glucose tolerance test was performed. Regression analyses were used to determine associations between plasma lopinavir concentrations and fasting and 2 hour plasma glucose, fasting cholesterol, and triglycerides concentrations.ResultsThere were 84 participants (72 women) with a median age of 36 years. The median blood pressure, body mass index and waist: hip ratio were 108/72 mmHg, 26 kg/m2 and 0.89 respectively. The median CD4 count was 478 cells/mm3. Median duration on lopinavir was 18.5 months. The median (interquartile range) lopinavir concentration was 8.0 (5.2 to 12.8) μg/mL. Regression analyses showed no significant association between lopinavir pre-dose concentrations and fasting cholesterol (β-coefficient −0.04 (95% CI −0.07 to 0.00)), triglycerides (β-coefficient −0.01 (95% CI −0.04 to 0.02)), fasting glucose (β-coefficient −0.01 (95% CI −0.04 to 0.02)), or 2-hour glucose concentrations (β-coefficient −0.02 (95% CI −0.09 to 0.06)). Lopinavir concentrations above the median were not associated with presence of dyslipidaemia or dysglycaemia.ConclusionsThere was no association between lopinavir plasma concentrations and plasma lipid and glucose concentrations.
Highlights
Ritonavir-boosted lopinavir (LPV/r) is a potent protease inhibitor (PI) widely used in a second-line antiretroviral regimens in low and middle-income countries [1]
Regression analyses showed no significant association between lopinavir pre-dose concentrations and fasting cholesterol (β-coefficient −0.04), triglycerides (β-coefficient −0.01), fasting glucose (β-coefficient −0.01), or 2-hour glucose concentrations (β-coefficient −0.02)
Lopinavir concentrations above the median were not associated with presence of dyslipidaemia or dysglycaemia
Summary
Ritonavir-boosted lopinavir (LPV/r) is a potent protease inhibitor (PI) widely used in a second-line antiretroviral regimens in low and middle-income countries [1]. Data regarding an association between plasma lopinavir and plasma glucose concentration are lacking. The aim of our study was to investigate whether there is an association between plasma lopinavir and plasma lipids and glucose concentrations. We hypothesized that higher plasma lopinavir concentrations would be associated with higher prevalence of dyslipidaemia and dysglycaemia. Dyslipidaemia and dysglycaemia have been associated with exposure to ritonavir-boosted protease inhibitors. Lopinavir/ritonavir, the most commonly used protease inhibitor in resource-limited settings, often causes dyslipidaemia. There are contradictory data regarding the association between lopinavir concentrations and changes in lipids
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