Serum Triglycerides, HIV Infection, and Highly Active Antiretroviral Therapy, Aquitaine Cohort, France, 1996 to 1998 [R Thiebaut, et al. JAIDS 2000; 23: 261]: The authors from France used a five-hospital system to examine the impact of antiretroviral therapy on triglyceride levels. There were 1,429 patients with at least two measurements and a median follow-up of 21 months. The mean change in serum triglyceride levels is summarized as follows: ritonavir - 106%, indinavir - 17%, nelfinavir - 27%, saquinavir - -2%, and no PI therapy - 0%.
Comment: This report seems to clearly implicate PI therapy as the cause of elevated triglycerides in patients with HIV infection, and ritonavir appeared to be the most problematic of the drugs tested. It is not known if this is a dose-related effect, but most assume it is, meaning that combination regimens that attempt to achieve therapeutic levels of ritonavir may be more hazardous than those using ritonavir for its PK effect exclusively. posted 6/6/2000