Antiviral therapy 2016 Oct 14() doi 10.3851/IMP3101
Cardiovascular disease (CVD) is an emerging concern for HIV-infected patients. Hyperlipidemia is a risk factor for CVD and a complication of protease-inhibitor-based antiretroviral therapy, but little is known about its incidence and risk factors in treated patients in resource-limited settings (RLS).
We conducted a secondary analysis of ACTG A5230 trial in which HIV-infected adults from India, Malawi, Tanzania, Thailand and South Africa, with virologic relapse on first line therapy were initiated on lopinavir/ritonavir (LPV/r) monotherapy. Hyperlipidemia was, a Grade 2+ elevated fasting total cholesterol (FTC≥240 mg/dl) or fasting triglycerides (FTG≥500 mg/dl) or calculated low density lipoprotein cholesterol (LDL≥160 mg/dl) based on measurements at weeks 12, 24, 48, 68 and 104. We evaluated factors potentially associated with quantitative lipid changes from baseline to week 12. These were age, sex, race, site, and baseline body mass index, CD4 cell count, HIV-1 RNA level, and lipids.
106 participants without hyperlipidemia at baseline started LPV/r; median age 39 years, 68% black African, 55% female. The cumulative incidence of hyperlipidemia at week 104 was 48% (95% CI: 36-58%). At week 12, there were significant mean increases from baseline in FTC (17 mg/dL, P<0.001) and FTG (104 mg/dL, P<0.001). In multivariable analysis, higher baseline FTC (P=0.044), FTG (P=0.025), Thai (P<0.001) or Indian sites (P=0.020) versus African sites were associated with increased risk of hyperlipidemia. CONCLUSIONS
In HIV-infected adults in RLS initiating LPV/r, hyperlipidemia was common. Baseline lipid measurements and routine monitoring should be recommended in individuals starting LPV/r-based treatments with borderline high lipids.