ＨＡＡＲＴによる高脂血症にフェノフィブラートが著効した１例

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  • Effective Treatment of Hyperlipidemia with Fenofibrate in a Patient with HIV Infection
  • ショウレイ ホウコク HAART ニ ヨル コウシケツショウ ニ フェノフィブラート ガ チョコウシタ 1レイ

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Objective: Many HIV-infected patients must undergo long-term highly active antiretroviral treatment (HAART), which can be associated with a variety of side effects that require careful management. We describe our successful treatment of a patient with hyperlipidemia resulting from HAART, using fenofibrate.<BR>Case Presentation: A 28-year-old man diagnosed with appendicitis was admitted to our hospital. Preoperative examinations disclosed that he was HIV-antibody positive. Peripheral blood showed 8.64×104 copies/ml of HIV RNA, CD4 cells numbered 160/μl, and the CD4/8 ratio was 0.14. Total cholesterol (TC), triglyceride (TG), LDL-cholesterol and HDLcholesterol were 201 mg/dl, 220 mg/dl, 120 mg/dl, and 55 mg/dl respectively. Medication with zidovudine in combination with lamivudine (Combivir), together with efavirentz (EFV), reduced HIV RNA below the limits of measurement, and CD4-positive lymphocytes increased. By 1 month later, however, TC and TG respectively had risen to 255 mg/dl and 406 mg/dl. EFV was changed to nevirapine (NVP) without improvement in hyperlipidemia, 18 months later TC and TG were 338 mg/dl and 2856 mg/dl. Pravastatin sodium was given, but TG did not decrease. After 24 months pravastatin sodium was replaced by fenofibrate, and TC and TG gradually were reduced. In addition to medication, exercise and dietary treatments were carried out. Current TC concentrations are between 200 and 230mg/dl, while TG values are 240 to 300mg/dl.<BR>Conclusion: Hyperlipidemia, a risk factor for atherosclerosis which in turn can cause coronary artery disease, is known as a serious side effect of HAART. Changing from EFV to NVP did not improve our patient's hyperlipidemia, indicating that hyperlipidemia was caused by a component of Combivir. Fenofibrate contributed to considerable correction of hyperlipidemia. Hyperlipidemia also may occur even in HAART-treated patients not receiving protease inhibitors. Regular monitoring of lipids is necessary in all patients undergoing HAART.

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