{"id":301,"date":"2009-03-14T16:38:30","date_gmt":"2009-03-14T21:38:30","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=301"},"modified":"2015-06-04T15:31:10","modified_gmt":"2015-06-04T19:31:10","slug":"maybe-its-not-the-cheeseburgers","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/maybe-its-not-the-cheeseburgers\/2009\/03\/14\/","title":{"rendered":"Maybe It’s Not the Cheeseburgers"},"content":{"rendered":"

\"\"<\/a>… At least that’s the implied message in this nice paper<\/a> from the latest Annals of Internal Medicine<\/em>, which evaluated responses to lipid-lowering therapy among patients with and without HIV.<\/p>\n

The study included patients from the Kaiser Permanente of Northern California integrated health system, with 829 individuals with HIV and 6941 without.<\/p>\n

The quick summary is that those with HIV responded less well to lipid lowering drugs than the HIV negative patients — something that comes as no surprise to HIV providers, as we’ve scratched our heads for years while various statins, fibrates, and omega-3s have made barely a dent on some pretty scary lipid profiles.<\/p>\n

There were a couple of other key take-aways from the paper.\u00a0 Pravastatin — which just happens to have the fewest drug-drug interactions with HIV drugs — was less effective than other statins.\u00a0 (Oh well.)\u00a0 It’s been fairly unanimous among cardiologists I’ve spoken with that they consider pravastatin a fairly wimpy lipid-lowering drug.<\/p>\n

In addition, those on boosted PIs had a blunted triglyceride response to gemfibrizol compared to patients on other forms of HIV therapy.\u00a0 These are, of course, the very people who need triglyceride-lowering the most!<\/p>\n

In practice, most patients on a boosted PI are on it for a reason — resistance, contraindications or intolerance to other drugs — so switching them off of it is rarely straightforward.\u00a0 (See this cautionary tale<\/a> from CROI.)\u00a0 Regardless, we can certainly include “lipid friendly” in our list of desirable attributes for the investigational<\/a> PK boosters<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

… At least that’s the implied message in this nice paper from the latest Annals of Internal Medicine, which evaluated responses to lipid-lowering therapy among patients with and without HIV. The study included patients from the Kaiser Permanente of Northern California integrated health system, with 829 individuals with HIV and 6941 without. The quick summary […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,4,5,8],"tags":[62,83,144,357,380,431,450,566,672,744],"class_list":["post-301","post","type-post","status-publish","format-standard","hentry","category-health-care","category-hiv","category-infectious-diseases","category-patient-care","tag-annals-of-internal-medicine","tag-art","tag-cardiologists","tag-fibrates","tag-gemfibrizol","tag-hiv-drugs","tag-hiv-therapy","tag-lipid-lowering-drugs","tag-omega","tag-pravastatin"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/301","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=301"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/301\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=301"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=301"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=301"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}