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Impact of second-line antiretroviral regimens on lipid profiles in an African setting: the DART trial sub-study.

Gomo ZA, Hakim JG, Walker SA, Tinago W, Mandozana G, Kityo C, Munderi P, Katabira E, Reid A, Gibb DM, Gilks CF, DART Te - AIDS Res Ther (2014)

Bottom Line: Initial second-line regimens were LPV/r + NNRTI in 27(41%), LPV/r + NNRTI + ddI in 33(50%) and LPV/r + TDF + ddI/3TC/ZDV in 6(9%).Modest lipid elevations were observed in African patients on predominantly LPV/r + NNRTI-based second-line regimens.Routine lipid monitoring during second-line ART regimens may not be warranted in this setting but individual cardiovascular risk assessment should guide practice.

View Article: PubMed Central - PubMed

Affiliation: Department of Chemical Pathology, College of Health Sciences, University of Zimbabwe, Avondale, PO Box A178 Harare, Zimbabwe.

ABSTRACT

Background: Increasing numbers of HIV-infected patients in sub-Saharan Africa are exposed to antiretroviral therapy (ART), but there are few data on lipid changes on first-line ART, and even fewer on second-line.

Methods: DART was a randomized trial comparing monitoring strategies in Ugandan/Zimbabwean adults initiating first-line ART and switching to second-line at clinical/immunological failure. We evaluated fasting lipid profiles at second-line initiation and ≥48 weeks subsequently in stored samples from Zimbabwean patients switching before 18 September 2006.

Results: Of 91 patients switched to second-line ART, 65(73%) had fasting samples at switch and ≥48 weeks, 14(15%) died or were lost <48 weeks, 10(11%) interrupted ART for >14 days and 2(2%) had no samples available. 56/65(86%) received ZDV/d4T + 3TC + TDF first-line, 6(9%) ZDV/d4T + 3TC + NVP and 3(5%) ZDV + 3TC with TDF and NVP. Initial second-line regimens were LPV/r + NNRTI in 27(41%), LPV/r + NNRTI + ddI in 33(50%) and LPV/r + TDF + ddI/3TC/ZDV in 6(9%). At second-line initiation median (IQR) TC, LDL-C, HDL-C and TG (mmol/L) were 3.3(2.8-4.0), 1.7(1.3-2.2), 0.7(0.6-0.9) and 1.1(0.8-1.9) respectively. Levels were significantly increased 48 weeks later, by mean (SE) +2.0(0.1), +1.1(0.1), +0.5(0.05) and +0.4(0.2) respectively (p < 0.001; TG p = 0.01). 3% at switch vs 25% 48 weeks later had TC >5.2 mmol/L; 3% vs 25% LDL-C >3.4 mmol/L and 91% vs 41% HDL-C <1.1 mmol/L (p < 0.001). Similar proportions had TG >1.8 mmol/L (0 vs 3%) and TC/HDL-C ≥5 (40% vs 33%) (p > 0.15).

Conclusion: Modest lipid elevations were observed in African patients on predominantly LPV/r + NNRTI-based second-line regimens. Routine lipid monitoring during second-line ART regimens may not be warranted in this setting but individual cardiovascular risk assessment should guide practice.

No MeSH data available.


Related in: MedlinePlus

Fasting plasma lipids at switch to second-line and 48 weeks later. Footnote 1: Total Cholesterol (TC), Low-density lipoprotein-cholesterol (LDL-C), High-density lipoprotein-cholesterol (HDL-C) and triglycerides (TG) levels were statistically significantly increased ≥48 weeks on switching to second-line ART regimens (p < 0.001).
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Fig1: Fasting plasma lipids at switch to second-line and 48 weeks later. Footnote 1: Total Cholesterol (TC), Low-density lipoprotein-cholesterol (LDL-C), High-density lipoprotein-cholesterol (HDL-C) and triglycerides (TG) levels were statistically significantly increased ≥48 weeks on switching to second-line ART regimens (p < 0.001).

Mentions: Fasting lipid profiles (TC, LDL-C, HDL-C, TC/HDL-C ratio and TG) after ≥48 weeks of second-line ART are shown in Table 2; TC, LDL-C and HDL-C remained higher in women persisted, and associations between higher TC, LDL-C and TG and higher BMI strengthened. Lipid levels were significantly increased after ≥48 weeks of second-line ART, by (mean mmol/L) TC +2.0, LDL-C +1.1, HDL-C +0.5 (all p < 0.001) and TG +0.40 (p = 0.01) (Table 3, Figure 1). The percentage increase in lipid levels after ≥48 weeks of second-line ART was TC 59%, LDL-C 61%, HDL-C 71% and TG 29% (Table 3). There was no significant change in TC/HDL-C ratio, p = 0.94 (Table 3).Table 2


Impact of second-line antiretroviral regimens on lipid profiles in an African setting: the DART trial sub-study.

Gomo ZA, Hakim JG, Walker SA, Tinago W, Mandozana G, Kityo C, Munderi P, Katabira E, Reid A, Gibb DM, Gilks CF, DART Te - AIDS Res Ther (2014)

Fasting plasma lipids at switch to second-line and 48 weeks later. Footnote 1: Total Cholesterol (TC), Low-density lipoprotein-cholesterol (LDL-C), High-density lipoprotein-cholesterol (HDL-C) and triglycerides (TG) levels were statistically significantly increased ≥48 weeks on switching to second-line ART regimens (p < 0.001).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4197260&req=5

Fig1: Fasting plasma lipids at switch to second-line and 48 weeks later. Footnote 1: Total Cholesterol (TC), Low-density lipoprotein-cholesterol (LDL-C), High-density lipoprotein-cholesterol (HDL-C) and triglycerides (TG) levels were statistically significantly increased ≥48 weeks on switching to second-line ART regimens (p < 0.001).
Mentions: Fasting lipid profiles (TC, LDL-C, HDL-C, TC/HDL-C ratio and TG) after ≥48 weeks of second-line ART are shown in Table 2; TC, LDL-C and HDL-C remained higher in women persisted, and associations between higher TC, LDL-C and TG and higher BMI strengthened. Lipid levels were significantly increased after ≥48 weeks of second-line ART, by (mean mmol/L) TC +2.0, LDL-C +1.1, HDL-C +0.5 (all p < 0.001) and TG +0.40 (p = 0.01) (Table 3, Figure 1). The percentage increase in lipid levels after ≥48 weeks of second-line ART was TC 59%, LDL-C 61%, HDL-C 71% and TG 29% (Table 3). There was no significant change in TC/HDL-C ratio, p = 0.94 (Table 3).Table 2

Bottom Line: Initial second-line regimens were LPV/r + NNRTI in 27(41%), LPV/r + NNRTI + ddI in 33(50%) and LPV/r + TDF + ddI/3TC/ZDV in 6(9%).Modest lipid elevations were observed in African patients on predominantly LPV/r + NNRTI-based second-line regimens.Routine lipid monitoring during second-line ART regimens may not be warranted in this setting but individual cardiovascular risk assessment should guide practice.

View Article: PubMed Central - PubMed

Affiliation: Department of Chemical Pathology, College of Health Sciences, University of Zimbabwe, Avondale, PO Box A178 Harare, Zimbabwe.

ABSTRACT

Background: Increasing numbers of HIV-infected patients in sub-Saharan Africa are exposed to antiretroviral therapy (ART), but there are few data on lipid changes on first-line ART, and even fewer on second-line.

Methods: DART was a randomized trial comparing monitoring strategies in Ugandan/Zimbabwean adults initiating first-line ART and switching to second-line at clinical/immunological failure. We evaluated fasting lipid profiles at second-line initiation and ≥48 weeks subsequently in stored samples from Zimbabwean patients switching before 18 September 2006.

Results: Of 91 patients switched to second-line ART, 65(73%) had fasting samples at switch and ≥48 weeks, 14(15%) died or were lost <48 weeks, 10(11%) interrupted ART for >14 days and 2(2%) had no samples available. 56/65(86%) received ZDV/d4T + 3TC + TDF first-line, 6(9%) ZDV/d4T + 3TC + NVP and 3(5%) ZDV + 3TC with TDF and NVP. Initial second-line regimens were LPV/r + NNRTI in 27(41%), LPV/r + NNRTI + ddI in 33(50%) and LPV/r + TDF + ddI/3TC/ZDV in 6(9%). At second-line initiation median (IQR) TC, LDL-C, HDL-C and TG (mmol/L) were 3.3(2.8-4.0), 1.7(1.3-2.2), 0.7(0.6-0.9) and 1.1(0.8-1.9) respectively. Levels were significantly increased 48 weeks later, by mean (SE) +2.0(0.1), +1.1(0.1), +0.5(0.05) and +0.4(0.2) respectively (p < 0.001; TG p = 0.01). 3% at switch vs 25% 48 weeks later had TC >5.2 mmol/L; 3% vs 25% LDL-C >3.4 mmol/L and 91% vs 41% HDL-C <1.1 mmol/L (p < 0.001). Similar proportions had TG >1.8 mmol/L (0 vs 3%) and TC/HDL-C ≥5 (40% vs 33%) (p > 0.15).

Conclusion: Modest lipid elevations were observed in African patients on predominantly LPV/r + NNRTI-based second-line regimens. Routine lipid monitoring during second-line ART regimens may not be warranted in this setting but individual cardiovascular risk assessment should guide practice.

No MeSH data available.


Related in: MedlinePlus