Dyslipidaemia in HIV-infected women on antiretroviral therapy. Analysis of 922 patients from the Spanish VACH cohort

Abstract

BackgroundInformation concerning lipid disturbances in HIV-infected women on antiretroviral therapy (ART) is scarce. The objective of the study is to describe the lipid profile in a large cohort of HIV-infected women on contemporary ART and analyse differences between regimes and patient's characteristics.MethodsObservational, multicentre, cross-sectional study from the Spanish VACH Cohort. 922 women on stable ART without lipid-lowering treatment were included.ResultsMedian age was 42 years, median CD4 lymphocyte count was 544 cells/mm3, and 85.6% presented undetectable HIV-1 viral load. Median total cholesterol (TC) was 189 mg/dL (interquartile range, IQR, 165-221), HDL cholesterol 53 mg/dL (IQR, 44-64), LDL cholesterol 108 mg/dL (IQR, 86-134), and triglycerides 116 mg/dL (IQR, 85-163). Mean accumulated time on ART was 116 months; 47.4% were on NNRTI-based regimes, 44.7% on PI, and 6.7% on only-NRTI therapy. 43.8% were also hepatitis C (HCV) coinfected. Patients on PI treatment presented higher TC/HDL ratio than those on NNRTI (p < 0.001). Significantly higher HDL values were observed in NNRTI-treated patients. HCV-coinfected patients presented lower TC/HDL ratio than the non HCV-coinfected. In multivariate analysis, factors independently associated with TC/HDL ratio were age, triglyceride levels and HCV co-infection. PI treatment presented a non-significant association with higher TC/HDL ratio.ConclusionsIn HIV-infected women, the NNRTI-based ART is associated with a better lipid profile than the PI-based. Factors unrelated to ART selection may also exert an independent, significant influence on lipids; in particular, age, and triglyceride levels are associated with an increased TC/HDL ratio while HCV co-infection is associated with a reduced TC/HDL ratio.

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

“…The results of this study reinforce the notion that ART is associated with lipid profi le changes in patients with HIV 8,15,[17][18][19][20] . Because ART regimens lead to changes in the lipid profi le of HIV patients, there is controversy as to how to determine the best drug regimen in regards to the patient`s metabolic profi le.…”

“…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] .…”

“…In addition, lipid disorders are often observed in people living with HIV, and include elevations in total cholesterol (TC) and triglycerides (TG) and reduced levels of high-density lipoprotein (HDL) 8 .…”

Review of Cardiovascular Disease in HIV-Infected Women

“…Triant et al noted increased rates of hypertension, diabetes, and dyslipidemia stratified by gender in HIVinfected patients compared to HIV-uninfected patients [9] , and 95th percentiles of small LDL-p in women on HAART were higher than in HIV-infected and HAART Naïve (CI or p values not provided) women -After further adjustment for TG and HDL-C, the association between HAART and small LDL-p was no longer significant -HIV-uninfected women had higher total and small HDL-p than HIV-infected women at each of the percentiles. This remained significant after adjustment for TG and HDL-C Estrada et al [44]. but a lower prevalence of hypertension and obesity in HIV-infected women compared to HIV-uninfected women (p<0.05) [10].…”

“…Estrada et al demonstrated that HIV-infected women receiving nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens had better lipid profiles than HIV-infected women on PI-based regimens [44]. Shaffer et al evaluated CHD risk factors following initiation of NNRTI vs. PI-based ART in women from 7 countries in sub-Saharan Africa over 144 weeks.…”