Changes in lipid profile over 24-months among adults on first-line highly active Antiretroviral therapy in the home-based AIDS care program in rural Uganda
Changes in lipid profile over 24-months among adults on first-line highly active Antiretroviral therapy in the home-based AIDS care program in rural Uganda
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DOI：
10.1097/qai.0b013e31815e7453
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发表时间：
2008-03-01
影响因子：
3.6
通讯作者：
Brooks, John T.
中科院分区：
文献类型：
--
作者：
Buchacz, Kate;Weidle, Paul J.;Brooks, John T.
背景资料：在工业化国家，使用高效抗逆转录病毒疗法（HAART）与HIV感染患者的血脂异常和心血管疾病（CVD）风险增加有关。HAART对撒哈拉以南非洲人脂质代谢的影响，对他们来说，获得抗逆转录病毒疗法正在扩大，仍然在很大程度上unknown.Methods：从2003年7月至2004年5月，987名抗逆转录病毒初治的有症状的HIV疾病或CD 4计数< 250个细胞/mm（3）的患者开始在乌干达托罗罗的家庭艾滋病护理（HBAC）计划HAART。HBAC计划提供每周药物交付和现场临床监测。分析了来自374名患者的非空腹储存血清的基线总胆固醇（TC）、直接低密度脂蛋白胆固醇（LDL-c）、直接高密度脂蛋白胆固醇（HDL-c）和甘油三酯（TG）水平（HAART前）和HAART后12个月和24个月，使用Randox酶试剂盒结果：374名患者接受了评估（49%的女性，平均年龄= 39岁，CD 4计数= 124个细胞/mm 3，体重指数= 19.7 kg/m2）接受了由司他夫定，拉米夫定，奈韦拉平（365例患者[98%]）或依法韦仑（9例患者[2%]）。在24个月内，99例（26%）患者单药替换司他夫定齐多夫定，27例（7%）单药替换奈韦拉平依法韦仑。基线时，TC、LDL-c、HDL-c和TG的平均血清脂质浓度分别为120 mg/dL、53 mg/dL、29 mg/dL和123 mg/dL;男性和女性的数值基本相当。在24个月的治疗期间，TC平均增加31 mg/dL，LDL-c平均增加26 mg/dL，HDL-c平均增加19 mg/dL，而TC/HDL-c比值从平均4.6降至3.4（所有变化，P < 0.001）。TG水平最初下降，然后在24个月时恢复到基线水平。在基线和24个月时，分别有2%和10%的患者TC>= 200 mg/dL，LDL-c为！130 mg/dL为1%和6%，HDL-c < 40 mg/dL为88%和41%，TG>= 150 mg/dL为23%和20%。结论：乌干达农村晚期HIV患者开始奈韦拉平或依法韦仑HAART治疗时，基线和治疗24个月后TC、LDL-c和TG升高的情况不常见。HDL-c水平的增加显著且成比例地大于TC或LDL-c水平的增加。心血管疾病的风险以及它是如何受到影响的脂质变化在这个农村非洲人口是未知的。然而，我们在HAART治疗24个月后观察到的变化似乎不太可能增加CVD的风险。
Background: Use of highly active antiretroviral therapy (HAART) has been linked to dyslipidemia and increased risk of cardiovascular disease (CVD) in HIV-infected patients in industrialized countries. The effects of HAART on lipid metabolism among sub-Saharan Africans, for whom access to antiretroviral therapy is expanding, remain largely unknown.Methods: From July 2003 to May 2004, 987 antiretroviral-naive patients with symptomatic HIV disease or a CD4 count < 250 cells/mm(3) were started on HAART in the Home-Based AIDS Care (HBAC) Program in Tororo, Uganda. The HBAC Program provided weekly drug delivery and field-based clinical monitoring. Nonfasting repository sera from a subset of 374 patients were analyzed for levels of total cholesterol (TC), direct low-density lipoprotein cholesterol (LDL-c), direct high-density lipoprotein cholesterol (HDL-c), and triglycerides (TG) at baseline (before HAART) and after 12 and 24 months of HAART using Randox enzymatic kits (Crumlin, United Kingdom).Results: The 374 patients evaluated (49% women, mean age = 39 years, CD4 count = 124 cells/mm(3), body mass index = 19.7 kg/m(2)) received initial HAART composed of stavudine, lamivudine, and either nevirapine (365 patients [98%]) or efavirenz (9 patients [2%]). During 24 months, 99 (26%) patients had single drug substitutions from stavudine to zidovudine and 27 (7%) had single drug substitutions from nevirapine to efavirenz. At baseline, the mean serum lipid concentrations were 120 mg/dL for TC, 53 mg/dL for LDL-c, 29 mg/dL for HDL-c, and 123 mg/dL for TG; values were generally comparable for men and women. During 24 months of treatment, TC increased by a mean of 31 mg/dL, LDL-c by a mean of 26 mg/dL, and HDL-c by a mean of 19 mg/dL, whereas the TC/HDL-c ratio decreased from a mean of 4.6 to 3.4 (all changes, P < 0.001). TG levels initially decreased and then returned to baseline levels by 24 months. At baseline and 24 months, respectively, TC was >= 200 mg/dL for 2% and 10% of patients, LDL-c was ! 130 mg/dL for 1% and 6%, HDL-c was < 40 mg/dL for 88% and 41%, and TG were >= 150 mg/dL for 23% and 20%.Conclusions: Rural Ugandans with advanced HIV disease initiating nevirapine- or efavirenz-based HAART experienced infrequent elevations in TC, LDL-c, and TG at baseline and after 24 months of therapy. Increases in HDL-c levels were substantial and proportionally greater than increases in TC or LDL-c levels. The risk of CVD and how it is affected by lipid changes in this rural African population are unknown. However, the changes we observed after 24 months of HAART seem unlikely to increase the risk of CVD.