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Metabolsk syndrom |
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The prevalence of metabolic syndrome among these HIV-infected patients is similar to that previously reported in uninfected individuals. Of specifi c concerns is the association of protease inhibitor exposure with the metabolic syndrome and, more spesifi cally, with exposure to stavudine and lopinavir/ritonavir when individual antiretroviral drugs were analyzed
Jerico C et al “Metabolic syndrome among HIV-infected patients: prevalence, characteristics, and related factors.” Diabetes Care. 2005 Jan;28(1):132-7.
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| In summary, we show that ATV inhibits insulin-stimulated glucose uptake signifi icantly less than LPV at similar concentrations in vitro, and that RTV (2µmol/l) combined with ATV or LPV does not further inhibit glucose uptake beyond the level seen with individual drugs.
Noor M et al “Effects of atazanavir/ritonavir and lopinavir/ritonavir on glucose uptake and insulin sensitivity: demonstrable differences in vitro and clinically.” AIDS. 2006 Sep 11;20(14):1813-21 |
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Most of the PIs have some dyslipidaemic effect, especially ritonavir (alone or in combination
with other PIs). fosamprenavir and the novel PI tipraniavir. Only atazanavir, and to some extent saquinavir, seem to have little effect on lipid levels and glucose metabolism.
Bergersen BM “Cardiovascular risk in patients with HIV Infection: impact of antiretroviral therapy.” Drugs. 2006;66(15):1971-87. |
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In summary, a single dose of lopinavir-ritonavir avutely decreases insulin-mediated glucose
disposal but is not accompanied by an increase in adiponectin levels. These fi ndings differ
from the from the fi ndings of our previous study, in which 4 weeks of lopinavirr-ritonavir did not signifi cantly change insulin sensitivity. An increase in adiponectin levels during chronic administration may contribute to the amelioration in acute induction of insulin resistance.
Lee GA et al “Single-dose lopinavir-ritonavir acutely inhibits insulin-mediated glucose disposal in healthy volunteers.” Clin Infect Dis. 2006 Sep 1;43(5):658-60 |
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Treatment with lopinavir/ritonavir is signifi cantly associated with elevated BP, an effect that
appears to be mediated through an increase in BMI. Patients receiving atazanavir were least likely to develop elevated BP. The impact of antiretroviral medications on cardiovascular disease risk factors will increasingly infl uence treatment decisions.
Crane HM et al “Antiretroviral medications associated with elevated blood pressure among patients receiving highly active antiretroviral therapy.” AIDS. 2006 Apr 24;20(7):1019-26. |
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Atazanavir har the most favourable metabolic profi le of all the PIs, and does not pertub lipid
metabolism or insulin sensitivity to any signifi cant extent (44-46). Part of the explanation
might be the relative lack of effect of atazanavir on the GLUT4 enzyme pathway, or other
associated enzyme pathways.
M Aboud et al. Int J Clin Pract, March 2007, 61, 3, 463-472 |
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| The estimated median survival is more than 35 years for a young person diagnosed with HIV infection in the late highly active antiretroviral therapy era. However, an ongoing effort is still needed to further reduce mortality rates for these persons compared with the general population.
Nicolai Lohse et al, Ann Intern Med. 2007;146:87-95 |
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Boostret Reyataz og NRTI - kombinasjoner som doseres én gang daglig
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