Improvement in lipid profiles over 6 years of follow-up in adults with AIDS and immune reconstitution.

TitleImprovement in lipid profiles over 6 years of follow-up in adults with AIDS and immune reconstitution.
Publication TypeJournal Article
Year of Publication2009
AuthorsWilliams P, Wu J, Cohn S, Koletar S, McCutchan J, Murphy R, Currier J
Corporate AuthorsAIDS Clinical Trials Group 362 Study Team
JournalHIV Med
Volume10
Issue5
Pagination290-301
Date Published2009 May
ISSN1468-1293
KeywordsAcquired Immunodeficiency Syndrome, Adult, Anti-Retroviral Agents, Benzoxazines, Body Fat Distribution, Cardiovascular Diseases, Coronary Disease, Drug Therapy, Combination, Epidemiologic Methods, Female, Humans, Hyperlipidemias, Hypolipidemic Agents, Immune Reconstitution Inflammatory Syndrome, Male, Metabolic Syndrome X, Middle Aged, Treatment Outcome
Abstract

OBJECTIVES: The aim of the study was to evaluate long-term changes in lipids and to assess other coronary heart disease (CHD) risk factors in highly experienced AIDS patients with immune reconstitution, and to examine their association with antiretroviral therapy (ART).

METHODS: We evaluated 433 AIDS patients with prior severe immunosuppression and ART-based immune reconstitution, followed in a multicentre prospective observational study between 2000 and 2006. We estimated the prevalence at entry of hypercholesterolaemia and metabolic syndrome, and 10-year CHD risks. Trends in total cholesterol (TC), triglycerides (TG) and high-density lipoprotein (HDL) cholesterol were evaluated over time, and use of specific ART drugs at each study visit was assessed using mixed effect models, adjusting for CHD risk factors and use of lipid-lowering agents.

RESULTS: At entry to observational follow-up, 28% of the 433 subjects had hypercholesterolaemia and 15% had a predicted 10-year CHD risk above 20%. Average TC and fasting TG levels declined over the follow-up period (median=5.8 years), and these declines were associated with increased use of physician-prescribed lipid-lowering agents and changes in ART regimens. After adjustment for CHD risk factors, TC and TG levels were significantly higher for those on ritonavir-boosted protease inhibitors and those on nonnucleoside reverse transcriptase inhibitors (NNRTIs), particularly efavirenz, than for other patients.

CONCLUSIONS: Abnormalities in serum lipids were common at baseline but became less so over time, and this improvement was associated with increased use of lipid-lowering agents and selection of ART agents with less deleterious effects on lipids.

DOI10.1111/j.1468-1293.2008.00685.x
Alternate JournalHIV Med.
PubMed ID19220493
PubMed Central IDPMC2778216
Grant List1U01 AI69474 / AI / NIAID NIH HHS / United States
2 U01 AI25915 / AI / NIAID NIH HHS / United States
5M01 RR00044 / RR / NCRR NIH HHS / United States
AI25859 / AI / NIAID NIH HHS / United States
AI25868 / AI / NIAID NIH HHS / United States
AI25879 / AI / NIAID NIH HHS / United States
AI25924 / AI / NIAID NIH HHS / United States
AI276017 / AI / NIAID NIH HHS / United States
AI27658 / AI / NIAID NIH HHS / United States
AI27660 / AI / NIAID NIH HHS / United States
AI27661 / AI / NIAID NIH HHS / United States
AI27664 / AI / NIAID NIH HHS / United States
AI27665 / AI / NIAID NIH HHS / United States
AI27668 / AI / NIAID NIH HHS / United States
AI27670 / AI / NIAID NIH HHS / United States
AI27673 / AI / NIAID NIH HHS / United States
AI32770 / AI / NIAID NIH HHS / United States
AI32782 / AI / NIAID NIH HHS / United States
AI34835 / AI / NIAID NIH HHS / United States
AI38858 / AI / NIAID NIH HHS / United States
AI39156 / AI / NIAID NIH HHS / United States
AI46370 / AI / NIAID NIH HHS / United States
AI50410 / AI / NIAID NIH HHS / United States
K24 AI056933 / AI / NIAID NIH HHS / United States
K24 AI056933-05 / AI / NIAID NIH HHS / United States
K24 AI56933 / AI / NIAID NIH HHS / United States
M01 RR000044 / RR / NCRR NIH HHS / United States
M01 RR000044-45 / RR / NCRR NIH HHS / United States
RR00044 / RR / NCRR NIH HHS / United States
RR00046 / RR / NCRR NIH HHS / United States
RR00047 / RR / NCRR NIH HHS / United States
RR00051 / RR / NCRR NIH HHS / United States
RR00052 / RR / NCRR NIH HHS / United States
RR00096 / RR / NCRR NIH HHS / United States
U01 AI025915 / AI / NIAID NIH HHS / United States
U01 AI025915-13 / AI / NIAID NIH HHS / United States
U01 AI027658-110002 / AI / NIAID NIH HHS / United States
U01 AI027660 / AI / NIAID NIH HHS / United States
U01 AI027660-15 / AI / NIAID NIH HHS / United States
U01 AI038855 / AI / NIAID NIH HHS / United States
U01 AI038855-09 / AI / NIAID NIH HHS / United States
U01 AI069474 / AI / NIAID NIH HHS / United States
U01 AI069474-03 / AI / NIAID NIH HHS / United States
U01 AI38855 / AI / NIAID NIH HHS / United States
UO1 AI27658 / AI / NIAID NIH HHS / United States