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Lipids improved by switching from ritonavir to cobicistat as a booster for darunavir
Michael Carter, 2017-09-06 09:20:00

Switching from ritonavir to cobicistat is associated with significant improvements in cholesterol and triglyceride levels for people with dyslipidaemia, investigators from Spain report in HIV Medicine. Ritonavir was replaced with cobicistat to boost the protease inhibitor darunavir. Six months after the switch, cholesterol and triglycerides had significantly improved among people with lipid abnormalities at baseline.

“More than 50% of the total study population presented with dyslipidaemia at baseline,” comment the researchers. “A significant improvement in all lipid parameters, including HDL cholesterol, was seen 24 weeks after the switch in those subjects with hypercholesterolaemia at baseline, and triglyceride levels improved mainly in those who presented with hypertriglyceridaemia at baseline, while virological efficacy and immunological status were maintained after the replacement,” write the researchers. “These results indicate that replacement of ritonavir with cobicistat could decrease the percentage of subjects with dyslipidaemia associated with ART [antiretroviral therapy] and consequently cardiovascular risk.”

Cobicistat is an approved boosting agent for certain antiretroviral drugs, including the protease inhibitor darunavir (a co-formulation of the two drugs is now available under the brand names Rezolsta or Prezcobix). Clinical trials showed that cobicistat/darunavir is as safe and effective as ritonavir-boosted darunavir. Ritonavir has been associated with significant drug interactions and side-effects, including lipid abnormalities. Protease inhibitors boosted by ritonavir are a risk factor for the development of cardiovascular disease, which is a major cause of illness and death in people with HIV. The effect on lipids of switching from ritonavir to cobicistat has received little attention.