The non-nucleoside reverse transcriptase inhibitor delavirdine (Rescriptor,
marketed in the US by Pharmacia & Upjohn), has not been associated with
lipid increases in patients new to treatment in five large international trials,
Professor Brian Gazzard of London's Chelsea and Westminster Hospital told the
recent Nutrition in HIV Infection conference in Cannes.
However, people taking delavirdine were significantly more likely to have
cholesterol increases if they had previous experience of anti-HIV treatment
(although the total number with such increases was small in each study).
Triglycerides and glucose did not rise significantly in any study group, and
cholesterol did not increase significantly in any group of patients new to
treatment.
Detailed reports from the Cannes Nutrition in HIV Infection conference are
available from the International Association of Physicians in AIDS are at < href="http://www.iapac.org/nutritionidx.html#cannes99"
target=_blank>http://www.iapac.org/nutritionidx.html#cannes99
Increases in cholesterol, triglycerides and glucose have been common in
people taking protease inhibitors. It is suspected that these changes may be
linked to changes in body fat distribution, also known as the lipodystrophy
syndrome, which appears to affect around 50% of people who receive protease
inhibitor treatment for more than 18 months.
Increases in cholesterol and triglycerides on HAART have also caused concern
because they may also increase the long-term risk of heart disease in people who
have other significant risk factors for heart disease, such as a family
history.
The effects of other NNRTIs (nevirapine and efavirenz) on lipids and glucose
have not been reported in the same way, so it is impossible to tell whether
delavirdine is better than or equal to other drugs of the same type in its
effects on lipids. Although improvements in lipids have been reported in people
who switched from PIs to nevirapine, the effects of other NNRTIs have not been
investigated in such a large group of patients, or in comparison with drugs not
known to affect lipids substantially (NRTIs such as AZT, ddI and 3TC).
1878 people were reviewed from five studies in which people took delavirdine
with either ddI, AZT or AZT and 3TC, or else received nucleoside analogues
without delavirdine.
Delavirdine is currently available in the UK through an expanded access
programme to anyone with a CD4 count below 350 who has failed with another
treatment regime, or who may not be able to tolerate currently licensed drugs.
An application for European licensing was stalled in March when the European
Medicines Evaluation Agency asked to see data in combination with protease
inhibitors, and data from trials lasting longer than 24 weeks. The drug will be
reviewed again in September.