Only two patients in the combined NVP arm and two patients in the ATZ/r arm of the study experienced cardiac disorders of division of acquired immunodeficiency syndrome (DAIDS) grade 3 or 4. In the combined NVP arm, one patient experienced angina pectoris and one patient http://www.selleckchem.com/products/azd4547.html experienced myopericarditis. In the ATZ/r arm, one patient experienced MI, and another experienced cardiac failure. Primary data from the ARTEN study confirm that the favourable virological and immunological responses to NVP combined with TDF/FTC are maintained through 48 weeks of treatment and are noninferior

to those of ATZ/r [in combination with the same dual nucleoside reverse transcriptase inhibitor (NRTI) backbone] with a similar safety profile [23]. The data presented here also suggest a more favourable lipid profile with NVP than with ATZ/r when combined with TDF/FTC. There are many risk factors for CVD. Known factors include smoking, being overweight, lack of exercise, insulin resistance, elevated waist circumference, hypertension, elevated LDL-c, elevated triglycerides and low HDL-c. For HIV-infected patients receiving treatment with ARVs, the risk of CVD may be significantly greater than in the general population [27]. Increased levels of TG, TC and LDL-c, reduced levels of HDL-c, unfavourable changes in the TC:HDL-c ratio and lipodystrophy are common side effects in patients receiving certain ARV drugs

[1–4]. The cardiac disorders of DAIDS grade 3 or 4 reported in four patients in the ARTEN study (two in each arm) probably relate to pre-existing cardiovascular Oxymatrine risk factors, although a role of antiretroviral therapy (ART) cannot be ruled Carfilzomib out. With respect to serum lipid levels, traditionally LDL-c is recognized as the primary target of cholesterol-lowering therapy. However, full evaluation of lipid-related risk (i.e. TC, HDL-c, the TC:HDL-c ratio and TG levels) should

also be considered, as these measures play an important role as markers of cardiovascular risk [28]. Although ATZ/r use was associated with markedly lower LDL-c increases compared with NVP, LDL-c is known to be an incomplete measure of atherogenic lipoproteins because very low-density lipoprotein (VLDL) remnants are also likely to contribute to coronary heart disease [29]. In contrast, ApoB measurement includes all atherogenic lipoproteins, with each VLDL and LDL particle having one molecule of ApoB, making ApoB a more reliable measure of the concentration of proatherogenic particles [30]. The Apolipoprotein-related Mortality Risk (AMORIS) study showed that elevated ApoB levels were strongly related to increased cardiovascular risk and were also a stronger marker of cardiovascular risk than LDL-c [31]. In the current study, NVP-containing regimens showed no difference in ApoB, significantly greater increases in HDL-c and ApoA1, and an improved ApoB:ApoA1 ratio over 48 weeks compared with the ATZ/r regimen.