A Spanish study reported in HIV Medicine shows that switching from ritonavir to cobicistat significantly improved cholesterol and triglyceride levels for HIV-positive people living with abnormal amounts of lipids in the blood, a condition also known as dyslipidemia.
Prior findings show that increased inflammation one gets from having HIV creates metabolic changes. As a result, people are likely to have low levels of “good” HDL cholesterol, which contribute to heart disease but is, by itself, different from other harms like smoking and alcohol.
Those with comorbidities such as dyslipidemia obviously pose a higher risk.
The drug cobicistate is a boosting agent used for certain antiretroviral drugs, including darunavir. Cobicistate/darunavir combos are available under the brand names Rezolsta or Prezcobix.
While it's similar to ritonavir, researchers found that ritonavir is associated with various drug interactions and side effects, including lipid abnormalities, which clearly doesn't help those living with dyslipidemia. When taken with protease inhibitors, ritonavir become a risk factor.
“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,” researchers write. “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.”
The study consisted of 299 people who made the switch from ritonavir to cobicistat between December 2015 and May 2016. Their lipids were checked by physicians just before the switch, and then again six months later. The people’s viral loads were unaffected over the course of the study.
While an analysis of the study showed that the switch didn’t have a dramatic effect on cholesterol, it did have a rather significant decrease in triglyceride levels.
Researchers also concluded they aren’t able to exclude other possible cases for the resulted lipid changes, such as diet and exercise, reports AIDS Map.
Further study is needed to show these conclusions to be something worth investigating further.