. Author manuscript; available in PMC: 2016 Oct 7.

Published in final edited form as: Endocrinol Metab Clin North Am. 2014 Sep;43(3):665–684. doi: 10.1016/j.ecl.2014.06.003

Table 3.

Studies investigating the effects of different NNRTIs on lipids

NNRTIs	Comments
Efavirenz	Patients treated with efavirenz presented a significant increase of TC and triglyceride concentrations⁶³ compared with baseline. In the ACTG study 5202⁶⁴ participants randomly assigned to efavirenz had statistically significantly greater increases in TC and LDL-c concentrations but not in TC:HDL-c ratios compared with participants receiving atazanavir/ritonavir (each in combination with abacavir-lamivudine or tenofovir-emtricitabine). A recent meta-analysis compared the effects of the NNRTI, efavirenz, and various ritonavir-boosted PIs (including darunavir/ritonavir) on lipid levels using data from 15 clinical trials of first-line antiretroviral therapy in which standardized 48-wk lipids data were reported (n = 6368).⁶⁵ In this study, efavirenz and the more recently introduced PIs, such as DRV and atazanavir, had only a modest impact on serum lipids and their pattern of effect differed. In a substudy of a trial in 91 antiretroviral-naïve patients randomly assigned to tenofovir + emtricitabine + atazanavir/ritonavir or EFV (patients assigned to EFV had greater increases in TC, LDL-c, and HDL-c and in large HDL particles, but not in TC:HDL-c ratio or indication for lipid-lowering interventions relative to patients assigned to atazanavir and ritonavir.⁶⁶
Nevirapine	ART regimens containing nevirapine are associated with a favorable lipid profile, mainly because they provide higher serum concentrations of HDL-c.⁶³
Etravirine	Switching from efavirenz or ritonavir-boosted PIs to etravirine led to a significant improvement of lipids irrespective of the presence of previous hyperlipidemia and type of ART.⁶⁷
Rilpivirine	Two phase 3 trials (ECHO⁶⁸ and THRIVE⁶⁹) of similar design, with the exception of the background NRTI regimen, compared rilpivirine with efavirenz in ART-naive patients with HIV. After 48 wk, TC, HDL-c, LDL-c and triglyceride concentrations were significantly greater in the patients randomly assigned to efavirenz than those receiving rilpivirine; however, the TC:HDL-c ratio did not change significantly between the treatment groups because of a greater HDL increase in the patients given efavirenz.