First-line antiretroviral therapy and changes in lipid levels over 3 years among HIV-infected adults in Tanzania

Enju Liu*, Catharina Armstrong, Donna Spiegelman, Guerino Chalamilla, Marina Njelekela, Claudia Hawkins, Ellen Hertzmark, Nan Li, Eric Aris, Alfa Muhihi, Helen Semu, Wafaie Fawzi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Scopus citations

Abstract

Background. With the rapid rollout of antiretroviral therapy (ART) in sub-Saharan Africa (SSA), there has been an increasing concern about cardiovascular risks related to ART. However, data from human immunodeficiency virus (HIV)-infected populations from this region are very limited.Methods. Among 6385 HIV-infected adults in Dar es Salaam, Tanzania, we investigated the nonfasting lipid changes over 3 years following ART initiation and their associations with different first-line ART agents that are commonly used in SSA.Results. In the first 6 months of ART, the prevalence of dyslipidemia decreased from 69% to 54%, with triglyceride (TG) decreasing from 127 mg/dL to 113 mg/dL and high-density lipoprotein (HDL) cholesterol increasing from 39 mg/dL to 52 mg/dL. After 6 months, TG returned to its baseline level and increased to 139 mg/dL at 3 years; total cholesterol and low-density lipoprotein cholesterol continued to increase whereas HDL cholesterol leveled off. The prevalence of dyslipidemia increased to 73% after a 3-year follow-up. In multivariate analyses, patients on zidovudine-containing regimens had a greater reduction in TG levels at 6 months (-16.0 vs -6.3 mg/dL), and a lower increase at 3 years compared to patients on stavudine-containing regimens (2.1 vs 11.7 mg/dL, P <. 001); patients on nevirapine-based regimens had a higher increase in HDL cholesterol levels at 3 years compared to those on efavirenz-based regimens (13.6 vs 9.5 mg/dL, P =. 01).Conclusions. Our findings support the latest World Health Organization guidelines on the substitution of stavudine in first-line ART in resource-limited settings, and provide further evidence for selection of lipid-friendly ART for patients in SSA.

Original languageEnglish (US)
Pages (from-to)1820-1828
Number of pages9
JournalClinical Infectious Diseases
Volume56
Issue number12
DOIs
StatePublished - Jun 15 2013

Keywords

  • HIV
  • adults
  • antiretroviral therapy
  • cholesterol
  • triglyceride

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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