Impact of switching from human immunodeficiency virus type 1 protease inhibitors to efavirenz in successfully treated adults with lipodystrophy

We prospectively followed 20 consecutive patients with human immunodeficien cy virus type 1 (HIV-1) with viral loads of <200 RNA copies/mL. These patie nts had been treated with 2 nucleoside reverse transcriptase inhibitors and <greater than or equal to>1 HIV-1 protease inhibitor for greater than or e qual to3 months; they developed body changes consistent with lipodystrophy and requested they be switched from protease inhibitor to efavirenz, At bas eline and every 3 months, we assessed the following: body mass index, waist -to-hip ratio, regional fat thickness (assessed by sonography), fasting tot al and high-density lipoprotein cholesterol, triglycerides, glucose, insuli n, CD4(+) cells, and viral load. At baseline, hypertriglyceridemia (greater than or equal to 200 mg/dL) was present in 17 (85%) patients, hypercholest erolemia (greater than or equal to 200 mg/dL) in 14 (70%), and impaired fas ting glucose (greater than or equal to 110 mg/dL) in 8 (40%); CD4(+) T cell s were 280 X 10(6) cells/L (range, 64-942 X 10(6) cells/L). HIV-1 RNA had b een at <200 copies/mL for a median of 14 months (range, 3-24 months). Six m onths after switching to efavirenz, there was a reduction in triglyceride l evels (a decrease of 31%; P = .03) and fasting insulin resistance index Ca decrease of 28%; P = .03), but total and high-density lipoprotein cholester ol 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 remai ned stable (363 x 10(6) cells/L; range, 102-741 X 10(6) cells/L; P = .65). Nineteen patients (95%) had HIV-1 RNA levels that remained at <200 copies/m L. Although CD4+ response and viral suppression remained preserved after 6 months of switching from protease inhibitor to efavirenz, the benefits of t his approach on the evolution of lipodystrophy were limited, and our findin gs do not support its routine recommendation to treat lipodystrophy.