Metabolic effects associated to the highly active antiretroviral therapy (HAART) in AIDS patients

Abstract

The aim of this study was to evaluate the metabolic abnormalities (dyslipidaemia and insulin resistance) associated with highly active antiretroviral therapy (HAART) in AIDS patients, treated in Campo Grande, Mato Grosso do Sul, Brazil. The patients were distributed in five different groups: Group 1, HIV-infected without antiretroviral therapy; Group 2, with Zidovudine, Lamivudine and Efavirenz or Nevirapine; Group 3, with Zidovudine, Lamivudine and Protease Inhibitor; Group 4, with Stavudine, Lamivudine and Efavirenz or Nevirapine; and Group 5, with Stavudine, Lamivudine and Protease Inhibitor. The lipid and glucose profile were determined and statistics comparison was made. The findings of this study showed significant statistics elevations of total cholesterol and triglycerides levels in patients of Groups 3, 4 and 5, when comparing to patients of Groups 1 and 2. Significant differences were not observed between the groups in the others parameters evaluated: Glucose, HDL cholesterol and LDL cholesterol. Comparing two drugs of same class (NNRTI) through the subgroups II-efavirenz and II-nevirapine, significant differences in the serum levels of total cholesterol, triglycerides and glucose favorable to the subgroup II-NVP were observed. These findings suggest that combinations including Protease Inhibitors and/or Stavudine could cause more adverse metabolic effects, and if possible, should be avoided in patients with others cardiovascular risk factors to prevent the precocious atherosclerosis in AIDS patients receiving HAART.

Redistribuição de gordura corporal e alterações no metabolismo de lipídeos e glicose em pessoas vivendo com HIV/AIDS

“…Some recent researches conclude the use of HAART is not the only determinant of these changes in the nutritional profile (despite their direct association with adipose tissue and insulin resistance), but rather their sum with genetic, environmental and nutritional factors 25 . The prevalence of clinical dystrophy in this study was similar to the one found in another national study of similar size 23 . In an article by Soares et al 26 with 227 PLWHA, the prevalence of lipodystrophy found through subjective method was 40%, the highest prevalence was observed among women (44 versus 38.8%), as observed in our study (56.5 versus 48.6%).…”

“…When comparing the presence of metabolic adverse effects in the studied patients, it is observed that the prevalences of hypercholesterolemia, hypertriglyceridemia, elevated LDL and altered fasting glycemia are slightly higher than the prevalences found in the study by Domingos and colleagues, whose objective was to evaluate the presence of metabolic abnormalities in 292 PLWHA in HAART 23 . There was a greater prevalence of reduced HDL, considering our study had a higher one (67.6 versus 42.8%).…”

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

“…It is well known that PIs and NNRTIs induce derangements of lipid profile during ART [3-5,17,20]. However, evidence in support of the adverse effects of NNRTIs on lipid profile of HIV treated patients in sub-Saharan Africa are very limited [11,12].…”

“…However, the increased risk of atherothombotic cardiovascular disease associated with the described lipid derangement is well know [4,5,7,8,27] and would therefore suggest that treatment with first-line ART may actually have harmful effects on the cardiovascular health of our population. Our study, by nature is cross-sectional and inference about causal relationship is not possible.…”

“…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 [4].…”