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Expert Rev Anti Infect Ther. 2009 Dec;7(10):1159-63. doi: 10.1586/eri.09.110.

The SWITCHMRK studies: substitution of lopinavir/ritonavir with raltegravir in HIV-positive individuals.

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Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, 521 Parnassus Avenue, C-152, Box 0622, San Francisco, CA 94143, USA.


Protease inhibitors potently suppress HIV viral load but are often associated with metabolic disturbances such as dyslipidemias and lipodystrophy. In addition to exercise, diet modification and anti-lipid therapies, one potential management strategy for HIV-positive patients with dyslipidemia is to switch any antiretrovirals that may be exacerbating the condition to more lipid-neutral drugs. The SWITCHMRK studies examined the effects of substituting lopinavir/ritonavir, a protease inhibitor known to cause dyslipidemias, with the integrase inhibitor raltegravir. Participants who switched from lopinavir/ritonavir to raltegravir experienced an improvement in cholesterol and triglycerides at 12 weeks; however, a large proportion of patients in the raltegravir arms did not maintain HIV virologic suppression at less than 50 copies/ml at week 24. Further analyses are underway to determine why more patients in the raltegravir arms experienced increased virologic failure and to determine whether switching lopinavir/ritonavir with raltegravir may be appropriate for specific subgroups of patients.

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