Treatment with pravastatin and fenofibrate improves atherogenic lipid profiles but not inflammatory markers in ACTG 5087.

TitleTreatment with pravastatin and fenofibrate improves atherogenic lipid profiles but not inflammatory markers in ACTG 5087.
Publication TypeJournal Article
Year of Publication2010
AuthorsFichtenbaum CJ, Yeh T-min, Evans SR, Aberg JA
JournalJ Clin Lipidol
Volume4
Issue4
Pagination279-87
Date Published2010 Jul-Aug
ISSN1933-2874
KeywordsAdiponectin, Adult, Aged, Anti-Retroviral Agents, Anticholesteremic Agents, Apolipoproteins A, Apolipoproteins B, Biomarkers, C-Reactive Protein, Drug Administration Schedule, Dyslipidemias, Female, Fenofibrate, HIV Infections, Humans, Male, Middle Aged, P-Selectin, Plasminogen Activator Inhibitor 1, Pravastatin, RNA, Viral
Abstract

OBJECTIVES: Statins and fibrates alter lipids, apolipoproteins and inflammatory markers in persons without HIV. The objective of this study was to evaluate changes in lipoproteins, apolipoproteins and other markers of inflammation with the use of pravastatin and fenofibrate.

DESIGN: Evaluation of participants in ACTG A5087, a randomized trial of pravastatin 40 mg/day or fenofibrate 200 mg/day for the treatment of dyslipidemia. Participants that failed single-agent therapy at week 12 were given the combination.

METHODS: Participants with available specimens were tested for apolipoproteins A1 and B, adiponectin, plasminogen-activator inhibitor type 1 (PAI-1), P-selectin, and high-sensitivity C-reactive protein (hs-CRP).

RESULTS: 74 participants (37 per randomized arm) received either pravastatin or fenofibrate for 12 weeks with 60 receiving combination treatment from weeks 12-48. There were no significant changes in hs-CRP, PAI-1, and P-selectin. From baseline to week 12, the median Apo B levels (-8 mg/dL, P=0.01 for fenofibrate and -27 mg/dL, P<0.01 for pravastatin) and ApoB/A1 ratios (-0.16, P<0.01 for both arms) significantly decreased. From baseline to week 48, median adiponectin (-1 ng/dL, P<0.01), Apo B (-22 mg/dL, P<0.01) and Apo B/A1 ratios (-0.2, P<0.01) all decreased in those who went on combination therapy, whereas Apo A1 (9.5 mg/dL, P=0.01) levels increased.

CONCLUSION: Treatment with pravastatin or fenofibrate improves the atherogenic lipid profile within the first 12 weeks and is sustained through 48 weeks with combination therapy. Adiponectin levels decrease with lipid-lowering therapy. However, markers of inflammation and platelet activation were not appreciably changed suggesting that the biologic properties of these agents differ in persons with HIV infection.

DOI10.1016/j.jacl.2010.04.003
Alternate JournalJ Clin Lipidol
PubMed ID20824151
PubMed Central IDPMC2932453
Grant ListU01 AI027665 / AI / NIAID NIH HHS / United States
U01 AI027665-18S2 / AI / NIAID NIH HHS / United States
U01 AI038855 / AI / NIAID NIH HHS / United States
U01 AI038855-09S2 / AI / NIAID NIH HHS / United States
U01 AI068634 / AI / NIAID NIH HHS / United States
U01 AI068634-05 / AI / NIAID NIH HHS / United States
U01 AI069513-05 / AI / NIAID NIH HHS / United States
U01 AI069532 / AI / NIAID NIH HHS / United States
U01 AI069532-04 / AI / NIAID NIH HHS / United States