Cardiometabolic risk factors among HIV patients on antiretroviral therapy

Abstract

Background: HIV and combination antiretroviral therapy (cART) may increase cardiovascular disease (CVD) risk. We assessed the early effects of cART on CVD risk markers in a population with presumed low CVD risk.

Methods: Adult patients (n=118) in Lusaka, Zambia were recruited at the time of initiation of cART for HIV/AIDS. Cardiometabolic risk factors were measured before and 90 days after starting cART. Participants were grouped according to cART regimens: Zidovudine + Lamivudine + Nevirapine (n=58); Stavudine + Lamivudine + Nevirapine (n=43); and 'other' (Zidovudine + Lamivudine + Efavirenz, Stavudine + Lamivudine + Efavirenz, Tenofovir + Emtricitabine + Efavirenz or Tenofovir + Emtricitabine + Nevirapine, n=17). ANOVA was used to test whether changes in cardiometabolic risk markers varied by cART regimen.

Results: From baseline to 90 days after initiation of cART, the prevalence of low levels of high-density lipoprotein cholesterol (<1.04 mmol/L for men and <1.30 mmol/L for women) significantly decreased (78.8% vs. 34.8%, P<0.001) while elevated total cholesterol (TC ≥5.18 mmol/L, 5.1% vs. 11.9%, P=0.03) and the homeostasis model assessment of insulin resistance ≥3.0 (1.7% vs. 17.0%, P<0.001) significantly increased. The prevalence of TC:HDL-c ratio ≥5.0 significantly decreased (44.9% vs. 6.8%, P<0.001). These changes in cardiometabolic risk markers were independent of the cART regimen.

Conclusion: Our results suggest that short-term cART is associated with a cardioprotective lipid profile in Zambia and a tendency towards insulin resistance regardless of the cART regimen.

Figure 1

Prevalence of abnormal lipid and other cardiometabolic risk factors at baseline and 90 days following cART initiation in the DGPLEAD study. Comparing baseline measurements to those at 90 days following initiation of therapy, there was a significant change in the proportion of patients with low HDL-c (P<0.001), TC ≥5.18 mmol/L (P=0.03), TC:HDL-c ≥ 5.0 (P<0.001), HOMA-IR ≥3.0 (P<0.001) and BMI <18.5 (P<0.001). There was no significant change (P>0.05) in LDL-c ≥3.37 mmol/L, triglycerides ≥1.70 mmol/L and glucose ≥5.55 mmol/L. * Low HDL-c was defined as <1.04 mmol/L in men and <1.30 mmol/L in women. BMI, Body Mass Index; HDL-c, High Density Lipoprotein Cholesterol; HOMA-IR, Homeostasis Model Assessment of Insulin Resistance; LDL-c, Low Density Lipoprotein Cholesterol; TC, Total Cholesterol.