Program Schedule

1567
Simplification to elvitegravir/cobicistat/emtricitabine/tenofovir DF from ritonavir-boosted protease inhibitor plus emtricitabine/tenofovir DF maintains HIV suppression and improves fasting triglycerides at week 48

Session: Poster Abstract Session: HIV Treatment: Outcomes, Adherence, and Toxicities
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: A higher triglyceride (TG) concentration is marginally independently associated with an increased risk of myocardial infarction in the D:A:D study. Patients switched to elvitegravir/cobicistat/emtricitabine/tenofovir DF (EVG/COBI/FTC/TDF) from ritonavir-boosted protease inhibitor (PI+RTV) plus FTC/TDF maintained high rates of virologic suppression at week 48 (94% vs 87%); and, overall had improvement in fasting triglyceride concentrations.

Methods: In the STRATEGY-PI study, fasting lipid parameters were measured at baseline and subsequent study visits. Subgroup analysis by PI examines the change from baseline (mg/dL) in fasting lipids and shifts in proportions of subjects with target lipid parameter by the National Cholesterol Educational Program (NCEP) category.  

Results: 293 subjects switched to EVG/COBI/FTC/TDF; 139 continued PI+RTV (51 atazanavir [ATV], 60 darunavir [DRV], 23 lopinavir [LPV], 5 other PIs). Switching to EVG/COBI/FTC/TDF versus continuation of PI+RTV resulted in statistically significant decrease from baseline in fasting TG concentrations at week 48 (mean:  -29 vs 1; p=0.001), driven primarily by decreases in TGs when switched to EVG/COBI/FTC/TDF from LPV (mean: -59 vs -1; p=0.003) or ATV (mean: -32 vs 5; p=0.014). Proportions of subject with target TG by NCEP category at week 48 that were statistically different between groups are shown below.  Changes in other fasting lipid parameters were generally small and not statistically different between groups except for a small increase in HDL (mean: 2 vs -1; p=0.03) and decrease in total cholesterol (TC)/HDL ratio (mean: -0.2 vs 0.0; p=0.029) for subjects who switched to EVG/COBI/FTC/TDF from DRV, and decreases in TC (mean: -24 vs 2; p=0.002) and HDL (mean: -2 vs  6; p=0.016) for subjects who switched to EVG/COBI/FTC/TDF from LPV.

Target Triglyceride (<150 mg/dL) by National Cholesterol Educational Program Category at W48

% (n)

EVG/COBI/FTC/TDF (n=250)

PI+RTV+FTC/TDF (n=112)

P Value

Baseline

63% (172)

64% (86)

0.94

Week 48

77% (206)

68% (80)

0.041

 

EVG/COBI/FTC/TDF (n=49)

LPV/RTV+FTC/TDF (n=23)

 

Baseline

34% (15)

33% (7)

0.92

Week 48

78% (35)

53% (10)

0.044

Conclusion: Switch to EVG/COBI/FTC/TDF maintained HIV suppression and improved fasting triglyceride concentrations, particularly in those switched from LPV or ATV.

Douglas Cunningham, DO1, David Shamblaw, MD2, Christine Zurawski, MD3, William Robbins, MD4, Anthony Scarsella, MD5, Thai Nguyen, MD6, Jason Hindman, PharmD6, Ramin Ebrahimi, MS6 and David Piontkowsky, MD6, (1)Pueblo Family Physicians, Phoenix, AZ, (2)La Playa Medical Group, San Diego, CA, (3)Atlanta ID Group, Atlanta, GA, (4)Value Health MD, LLC, Orlando, FL, (5)Pacific Oaks Medical Group, Beverly Hills, CA, (6)Gilead Sciences, Foster City, CA

Disclosures:

D. Cunningham, Gilead Sciences: Investigator, Research support

D. Shamblaw, Gilead Sciences: Consultant, Investigator and Speaker's Bureau, Consulting fee, Research support and Speaker honorarium
AbbVie: Speaker's Bureau, Speaker honorarium
Bristol-Meyers Squibb: Speaker's Bureau, Speaker honorarium

C. Zurawski, Gilead Sciences: Investigator and Scientific Advisor, Consulting fee and Research support

W. Robbins, Gilead Sciences: Investigator, Research support

A. Scarsella, Gilead Sciences: Investigator, Research support

T. Nguyen, Gilead Sciences: Employee, Salary

J. Hindman, Gilead Sciences: Employee, Salary

R. Ebrahimi, Gilead Sciences: Employee, Salary

D. Piontkowsky, Gilead Sciences: Employee, Salary

Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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