Improvement in lipid profiles over 6 years of follow‐up in adults with AIDS and immune reconstitution

Abstract

ObjectivesThe aim of the study was to evaluate long-term changes in lipids and to assess other coronary heart disease (CHD) risk factors in highly experienced AIDS patients with immune reconstitution, and to examine their association with antiretroviral therapy (ART). MethodsWe evaluated 433 AIDS patients with prior severe immunosuppression and ART-based immune reconstitution, followed in a multicentre prospective observational study between 2000 and 2006. We estimated the prevalence at entry of hypercholesterolaemia and metabolic syndrome, and 10-year CHD risks. Trends in total cholesterol (TC), triglycerides (TG) and high-density lipoprotein (HDL) cholesterol were evaluated over time, and use of specific ART drugs at each study visit was assessed using mixed effect models, adjusting for CHD risk factors and use of lipid-lowering agents. ResultsAt entry to observational follow-up, 28% of the 433 subjects had hypercholesterolaemia and 15% had a predicted 10-year CHD risk above 20%. Average TC and fasting TG levels declined over the follow-up period (median 5 5.8 years), and these declines were associated with increased use of physician-prescribed lipid-lowering agents and changes in ART regimens. After adjustment for CHD risk factors, TC and TG levels were significantly higher for those on ritonavir-boosted protease inhibitors and those on nonnucleoside reverse transcriptase inhibitors (NNRTIs), particularly efavirenz, than for other patients. ConclusionsAbnormalities in serum lipids were common at baseline but became less so over time, and this improvement was associated with increased use of lipid-lowering agents and selection of ART agents with less deleterious effects on lipids.

The development of antiretroviral therapy and its impact on the HIV-1/AIDS pandemic

“…The facts are different now, but even today prolonged survival has a corollary requiring the identification and careful management of the long-term effects of treatment (Hawkins, this issue). In this context, chronic antiretroviral therapy can bring about cardiac and metabolic side-effects, including dyslipidemias, insulin resistance, abnormal body fat re-distribution (lipodystrophy), and related disorders, which can in turn increase the risk for developing heart disease and type 2 diabetes (Sabin et al, 2008; Silverberg et al, 2009; Filardi et al, 2008; Williams et al, 2009). There is probably a higher risk for coronary artery disease in patients who receive protease inhibitors (Friis-Møller et al, 2007).…”

Dyslipidemia and Cardiovascular Risk in Human Immunodeficiency Virus Infection

“…11,63–70 Many studies have reported that NNRTI may induce greater increases in HDL levels compared with PIs, hence, balancing out the overall lipid risk profile. 70 Patients treated with efavirenz had increases of TC (at least 3% mean relative increase in levels) and triglyceride (at least 10% mean relative increase in levels) concentrations.…”

“…70 Patients treated with efavirenz had increases of TC (at least 3% mean relative increase in levels) and triglyceride (at least 10% mean relative increase in levels) concentrations. 63 Switching from a PI to efavirenz may improve the lipid profile, depending on the specific PI used. 71 With regard to other agents, the newer NNRTIs, rilpivirine and etravirine, have more favorable lipid profiles than efavirenz.…”

Metabolic Abnormalities in HIV-Infected Populations without or with Antiretroviral Therapy (ART)

“…Significant and positive effects of NNRTIs regimens are reported with regard to HDL-c values, as low HDL-c levels I. Interestingly, some prospective observational studies among two different populations of HIV-positive adults [103,184,185] and children [174,186] observed totally opposite results. Similar to tenofovir, which belongs to the NRTIS class, nevirapine [183,184] has beneficial effects such as dyslipidemia reduction.…”

“…Similar to tenofovir, which belongs to the NRTIS class, nevirapine [183,184] has beneficial effects such as dyslipidemia reduction. An adult study of 433 PLHIV [185] showed that the efavirenz (NNRTI) group and the ritonavir (PI) group had a significant upsurge in TC and TG concentrations, although the nevirapine group had the benefit of increased serum HDL-c levels [185]. Some studies did not detect a low quantity of HDL-c during nevirapine use in cases where the HIV viral load was undetected and completely controlled [27].…”