Date Published: September 26, 2011
Publisher: BioMed Central
Author(s): Eric Walter Pefura Yone, Awa Foueudjeu Betyoumin, André Pascal Kengne, François Jérome Kaze Folefack, Jeanne Ngogang.
Data on lipid profile derangements induced by antiretroviral treatment in Africa are scarce. The aim of this study was to determine the prevalence and characteristics of lipid profile derangements associated with first-line highly active antiretroviral therapy (ART) among Cameroonians living with human immunodeficiency virus (HIV) infection.
This cross-sectional study was conducted between November 2009 and January 2010, and involved 138 HIV patients who had never received ART (ART-naive group) and 138 others treated for at least 12 months with first line triple ART regimens that included nevirapine or efavirenz (ART group). Lipid profile was determined after overnight fast and dyslipidemia diagnosed according to the US National Cholesterol Education Program III criteria. Data comparison used chi-square test, Student t-test and logistic regressions.
The prevalence of total cholesterol ≥ 200 mg/dl was 37.6% and 24.6% respectively in ART group and ART-naive groups (p = 0.019). The equivalents for LDL-cholesterol ≥ 130 mg/dl were 46.4% and 21% (p ≤ 0.001). Proportions of patients with total cholesterol/HDL-cholesterol ratio ≥ 5 was 35.5% in ART group and 18.6% in ART-naive group (p ≤ 0.001). The distribution of HDL-cholesterol and triglycerides was similar between the two groups. In multivariable analysis adjusted for age, sex, body mass index, CD4 count and co-infection with tuberculosis, being on ART was significantly and positively associated with raised total cholesterol, LDL-cholesterol and TC/HDL cholesterol. The adjusted odd ratios (95% confidence interval, p-value) ART-treated vs. ART-naïve was 1.82 (1.06-1.12, p = 0.02) for TC ≥ 200 mg/dl; 2.99 (1.74-5.15), p < 0.0001) for LDL-cholesterol ≥ 130 mg/dl and 1.73 (1.04-2.89, p = 0.03) for TC/HDL-cholesterol ≥ 5. First-line antiretroviral therapy that includes nonnucleoside reverse transcriptase inhibitors is associated with pro-atherogenic adverse lipid profile in people with HIV-1 infection compared to untreated HIV-infected subjects in Yaounde. Lipid profile and other cardiovascular risk factors should be monitored in patients on such therapy so that any untoward effects of treatments can be optimally managed.
The advent of highly active antiretroviral therapy (HAART) has modified the natural history of human immunodeficiency virus (HIV) infection through reduction in risks of death associated with the condition and improvement of the quality of life of people living with the infection [1,2]. However, antiretroviral drugs also have side effects of varying order of severity. Derangements of lipid metabolism associated with HAART have been largely characterised in the West and in several developing countries, particularly in patients on treatment regimens including protease inhibitors (PIs) and stavudine [3,4], but also for treatment regimens including nevirapine and efavirenz [5,6]. Antiretroviral therapy (ART) can induce raised levels of total cholesterol (TC), LDL-cholesterol (LDL-c) and triglycerides (TG), and variables effects on HDL-cholesterol (HDL-c) levels . These ART-induced lipid derangements are potentially atherogenic and can increase cardiovascular risk [7,8]. First-line HAART regimens as defined by the World Health Organisation (WHO) and that are largely used in resources-constrained countries do not include PIs [9,10]. Evidences in support of lipid profile derangements associated with HAART in sub-Saharan Africa are scarce [11,12]. The aim of the present study was to determine the prevalence and determinants of derangements in lipid profile associated with the use of first-line ART regimens in Cameroonians with HIV infection.
The aim of this study conducted in a resource-poor setting was to assess the prevalence of, and characterise lipid abnormalities associated with the use of first-line ART regimens that include nonnucleoside reverse transcriptase inhibitors (NNRTIs). We found that patients on first-line ART had high levels of total cholesterol, LDL-c and high TC/HDL-c ratio as compared with ART-naïve patients. Serum levels of HDL-c and triglycerides were similar between HIV-infected untreated patients and HIV-infected patients on ART. The described derangements that are potentially atherogenic , were still present after adjustment for potential confounders.
In conclusion, WHO first-line HAART with regimens that include NNRTIs are associated with potentially atherogenic adverse lipid profile in patients with HIV-1 infection compared to untreated HIV-infected patients in our setting. This may indicate the need to update the current recommendations of WHO pertaining to biological monitoring of patients on first-line antiretroviral therapy to include lipid panel. Lipid profile and other cardiovascular risk factors should be monitored in patients on such therapy so that any untoward effects of ART can be optimally managed.
3TC: lamivudine; ART: antiretroviral therapy; AZT: zidovudine; d4T: stavudine; EFV: efavirenz; HAART: highly active antiretroviral therapy; HDL-c: HDL-cholesterol; HIV: human immunodeficiency virus; LDL-c: LDL-cholesterol; NNRTIs: nonnucleoside reverse transcriptase inhibitors; NVP: névirapine; PIs: protease inhibitors; TC: total cholesterol; TG: triglycerides Statical package for social sciences (SPSS); WHO: World Health Organisation.
The authors declare that they have no competing interests.
EWPY conceived and designed the study, performed analysis and interpretation of data and drafted the manuscript, AFB and APK assisted with the design, interpretation of data and the critical review of the manuscript. JFKF and JN performed critical review of the manuscript All authors approved and read the final manuscript.