Metabolic changes associated with antiretroviral therapy in HIV-positive patients

Introduction: Antiretroviral therapy (ART) has been used to treat large numbers of patients living with human immunodefi ciency virus (HIV) infection. Lipid disorders are often observed in these patients, and include elevations in total cholesterol (TC) and triglycerides (TG). Methods: A cross-sectional study was performed using 333 patient records from the Regional Hospital of São José Doutor Homero de Miranda Gomes (HRSJHMG). The study population consisted of patients with HIV who were under medical follow up, either on or off drug treatment. The data were entered into Excel and exported to SPSS 16.0 for analysis using chi-square testing. We used prevalence ratios as the measure of association. Results: Lipid abnormalities were observed in 78.9% of individuals who received ART. Of the 308 subjects on ART, 59.1%, 41.9%, and 33.1% had TG, TC and low-density lipoprotein (LDL) abnormalities, respectively. The prevalence of LDL changes was 2.57-fold higher in individuals who had been using ART for more than 12 months, compared to those using ART for 6 to 12 months. Conclusions: HIV patients showed a signifi cant increase in the association between TC and TG levels and the use of ART. In particular, changes in TC, LDL and TG were greater in individuals who had received ART for over more than 12 months.

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“…The mean age of the subjects included in the study was 43.3 years, similar to values reported in the literature 1,3,7,8,[15][16][17][18] .…”

Section: Discussionsupporting

confidence: 76%

Analysis of the prevalence of dyslipidemia in individuals with HIV and its association with antiretroviral therapy

Limas

Pinto

Marcato

et al. 2014

Rev. Soc. Bras. Med. Trop.

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“…However, there are suggestions that the magnitude of first-line ART induced lipid derangements could vary across populations and settings. Cross-sectional studies from other resources-constrained settings have reported prevalence of high level of total cholesterol ranging from 23 to 41% in patients treated with NNRTI-based regimens [15,21]. Based on LDL-c cut-points, we found a prevalence of dyslipidemia that was higher than that reported in Uganda [11] and in India [15].…”

Section: Discussioncontrasting

confidence: 45%

First-line antiretroviral therapy and dyslipidemia in people living with HIV-1 in Cameroon: a cross-sectional study

Yone

Betyoumin²,

Kengne

et al. 2011

AIDS Res Ther

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BackgroundData 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.MethodsThis 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.ResultsThe 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.ConclusionsFirst-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.

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“…However, within the same group, there was neither a reduction in lipids nor an increase in uric acid after the intervention. These data are in agreement with studies that demonstrate that lipid abnormalities are more evident among HIV-infected patients after the introduction of HAART [34][35][36][37] , and signifi cantly higher increases in lipids were observed when P Is were added to the antiretroviral scheme 38,39 . Therefore, it was observed that the compound employed did not provoke a signifi cant change in the lipid profi le of the study population during 3 months of dietary intervention.…”

Section: Discussionsupporting

confidence: 92%

The effects of a diet formulation with oats, soybeans, and flax on lipid profiles and uricemia in patients with AIDS and dyslipidemia

Ferreira

Cassaro

Domingos

et al. 2013

Rev. Soc. Bras. Med. Trop.

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Revista da Sociedade Brasileira de Medicina Tropical 46(6):691-697, Nov-Dec, 2013http://dx.doi.org/10.1590/0037-8682-0087-2013 INTRODUCTION ABSTRACT Introduction:Although the initiation of highly active antiretroviral therapy (HAART) is accompanied by an attenuation of viral load, metabolic disorders characterized by hyperglycemia, dyslipidemia, and lipodystrophy are often observed in patients under this treatment. Certain foods, such as oat bran, soy protein, and fl axseed, have been shown to improve a patient's lipid profi le despite possible increases in uricemia. Thus, a bioactive compound was formulated using these foods to help patients with HIV/ AIDS control metabolic disorders resulting from HAART. Methods: An uncontrolled before and after study was performed. The total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, and uric acid before and after 3 months of consuming the formulation were compared in patients. The compound was formulated such that 40g (the recommended daily intake) contained approximately 10g of fl axseed, 20g of oat bran, and 10g of textured soy protein. Results: The study population consisted of 139 patients, 31 of whom were included in the fi nal analysis. There were no signifi cant variations between the laboratory results obtained before and after consumption of the compound. Conclusions: The regular consumption of the formulation together with individualized dietary guidance did not reduce lipid levels and did not contribute to an increase in uricemia in the study group. However, new studies with higher doses of the foods that compose the formulation should be encouraged to investigate whether these foods can positively infl uence the lipid profi les of these patients.

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Metabolic changes associated with antiretroviral therapy in HIV-positive patients

Cited by 23 publications

References 18 publications

Analysis of the prevalence of dyslipidemia in individuals with HIV and its association with antiretroviral therapy

Analysis of the prevalence of dyslipidemia in individuals with HIV and its association with antiretroviral therapy

First-line antiretroviral therapy and dyslipidemia in people living with HIV-1 in Cameroon: a cross-sectional study

The effects of a diet formulation with oats, soybeans, and flax on lipid profiles and uricemia in patients with AIDS and dyslipidemia

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