Cardiovascular disease risk factors in HIV-infected women after initiation of lopinavir/ritonavir- and nevirapine-based antiretroviral therapy in Sub-Saharan Africa: A5208 (OCTANE).

TitleCardiovascular disease risk factors in HIV-infected women after initiation of lopinavir/ritonavir- and nevirapine-based antiretroviral therapy in Sub-Saharan Africa: A5208 (OCTANE).
Publication TypeJournal Article
Year of Publication2014
AuthorsShaffer D, Hughes MD, Sawe F, Bao Y, Moses A, Hogg E, Lockman S, Currier J
JournalJ Acquir Immune Defic Syndr
Volume66
Issue2
Pagination155-63
Date Published2014 Jun 1
ISSN1944-7884
KeywordsAdenine, Adult, Africa South of the Sahara, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, Blood Pressure, Body Mass Index, Cardiovascular Diseases, CD4-Positive T-Lymphocytes, Cholesterol, HDL, Cholesterol, LDL, Deoxycytidine, Emtricitabine, Endpoint Determination, Female, HIV Infections, HIV-1, Humans, Linear Models, Logistic Models, Lopinavir, Multivariate Analysis, Nevirapine, Organophosphonates, Prospective Studies, Risk Factors, Ritonavir, RNA, Viral, Tenofovir, Triglycerides
Abstract

BACKGROUND: Limited comparative, prospective data exist regarding cardiovascular risk factors in HIV-infected women starting antiretroviral therapy in Africa.

METHODS: In 7 African countries, 741 women with CD4 <200 cells/mm were randomized to tenofovir/emtricitabine (TDF/FTC) plus either nevirapine (NVP, n = 370) or lopinavir/ritonavir (LPV/r, n = 371). Lipids and blood pressure (BP) were evaluated at entry, 48, 96, and 144 weeks. Multivariable linear and logistic regression models were used to evaluate mean risk factor changes and clinically relevant risk factor changes.

RESULTS: At entry, both NVP and LPV/r groups were similar regarding age [mean = 33.5 (SD = 7.1) years], CD4 [129 (67) cells/mm], and HIV-1 RNA [5.1 (0.6) log10 copies/mL]. Nearly, all women had normal lipids and BP except for high-density lipoprotein (HDL)-cholesterol. Over 144 weeks, the LPV/r compared with NVP group had significantly greater mean lipid increases (eg, non-HDL: +29 vs. +13 mg/dL) and smaller HDL increases (+12 vs. +21 mg/dL). In contrast, the NVP compared with LPV/r group had greater mean increases in BP (eg, diastolic BP: +5 vs. -0.5 mm Hg). Significantly, more women assigned LPV/r had week 144 "abnormal" lipid levels (eg, HDL 29.7% vs. 14.8% and triglycerides 28.6% vs. 8.2%), and significantly, more women assigned NVP had "abnormal" BP (eg, diastolic BP 22.7% vs. 6.5%). Most differences remained significant when adjusted for baseline risk factor, age, CD4, and HIV-1 RNA.

CONCLUSIONS: In HIV-infected women initiating antiretroviral therapy in Africa, LPV/r + TDF/FTC was associated with less favorable changes in lipids, and use of NVP + TDF/FTC was associated with less favorable changes in BP.

DOI10.1097/QAI.0000000000000131
Alternate JournalJ. Acquir. Immune Defic. Syndr.
PubMed ID24562349
PubMed Central IDPMC4109714
Grant List5 U01AI069518 / AI / NIAID NIH HHS / United States
AI38838 / AI / NIAID NIH HHS / United States
AI68634 / AI / NIAID NIH HHS / United States
K24 AI056933 / AI / NIAID NIH HHS / United States
K24 AI56933 / AI / NIAID NIH HHS / United States
U01 AI068634 / AI / NIAID NIH HHS / United States
U01AI068636 / AI / NIAID NIH HHS / United States
UM1 AI068634 / AI / NIAID NIH HHS / United States
UM1 AI068636 / AI / NIAID NIH HHS / United States
UM1 AI069424 / AI / NIAID NIH HHS / United States
UM1 AI069456 / AI / NIAID NIH HHS / United States
UM1 AI106701 / AI / NIAID NIH HHS / United States
UM1 AI108568 / AI / NIAID NIH HHS / United States