Date Published: May 14, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Amit C. Achhra, Janaki Amin, Jennifer Hoy, Junko Tanuma, Thira Sirisanthana, David Nolan, Tuti Merati, Michelle Giles.
We explored the mean differences in routinely measured lipids (total cholesterol, triglycerides, and high-density lipoprotein cholesterol) according to exposure to different combination antiretroviral regimens in Asian (n = 2051) and Australian (predominantly Caucasian, n = 794) cohorts. The regimen was defined as at least 3 antiretroviral drugs with at least 2 nucleoside-reverse transcriptases (NRTIs) and either of at least one protease inhibitor (PI) or non-nucleoside-reverse transcriptases (NNRTIs). We categorised cART regimens as: NRTIs as tenofovir based or not; NNRTIs as nevirapine or efavirenz (but not both); and PI as atazanavir based or not. We found that the impact of various antiretroviral regimens on lipids in Asian and Australian cohorts was only different by cohort for total cholesterol (P for interaction between regimen and cohort: <0.001) but not in case of other lipids (P for interaction: >0.05). The differences in total cholesterol were however small and unlikely to be of clinical significance. Overall, tenofovir with nevirapine or atazanavir was associated with the most favorable lipids, while the PI regimens without tenofovir and atazanavir were associated with least favorable lipids. We conclude that the impact of various ART regimens on lipids is largely similar in Asian and Australian cohorts and that the newer drugs such as tenofovir and atazanavir are likely to provide similar benefit in terms of lipid profiles in both populations.
Combination antiretroviral therapy (cART) for HIV infection is associated with adverse changes in lipid profiles and can include elevation in total cholesterol and triglycerides, which may increase the risk of coronary heart disease (CHD) [1–4]. Moreover, different classes of cART and drugs within each class have differential impacts on lipids . Protease-inhibitors (PIs) are associated with more significant changes in lipid profile than nucleoside and nonnucleoside reverse transcriptase inhibitors (NRTIs and NNRTIs, resp.) [2, 3, 5]. And within NNRTI class, efavirenz (EFV) is associated with greater changes in the lipid profile than nevirapine (NVP) [2, 5, 6]. Also tenofovir (TDF) and atazanavir (ATV) are known to have a favorable impact on lipids [5, 7, 8].
There were 2845 participants (2051 in TAHOD and 794 in AHOD) who met the inclusion criteria. In TAHOD, 736 (35.9%) were Chinese, 654 (31.9%) were Thai, 152 (7.4%) were Cambodian (Khmer), 100 (4.9%) were Japanese and 62 (3%) were Indian. Table 1 describes the patient characteristics at study entry for each cohort.
In this study, we examined the mean differences in lipids between various cART regimens in TAHOD and AHOD cohorts. We found that the relationship between regimen and lipids differed by cohort only in the analysis of total cholesterol level. For total cholesterol, the magnitude of effect of regimen differed between cohorts such that TAHOD participants tended to have slightly lower total cholesterol for most regimens (most notably for the NRTIs (+TDF) + PI (+ATV) and the NRTIs + PI regimens). Overall, we found that the NRTIs (+TDF) + NVP and the NRTIs (+TDF) + PI (+ATV) regimens were associated with the most favorable lipid profile, whereas the NRTIs + PI and the NRTIs + EFV regimens were associated with the least favorable lipid profiles.