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.
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.
Authors: Mutsawashe Bwakura-Dangarembizi; Victor Musiime; Alexander J Szubert; Andrew J Prendergast; Zvenyika A Gomo; Margaret J Thomason; Cuthbert Musarurwa; Peter Mugyenyi; Patricia Nahirya; Adeodata Kekitiinwa; Diana M Gibb; Ann S Walker; Kusum Nathoo Journal: Pediatr Infect Dis J Date: 2015-02 Impact factor: 2.129
Authors: Anne Njoroge; B L Guthrie; Rose Bosire; Mark Wener; James Kiarie; Carey Farquhar Journal: Lipids Health Dis Date: 2017-06-09 Impact factor: 3.876
Authors: Alemayehu Amberbir; Victor Singano; Alfred Matengeni; Zahra Ismail; Gift Kawalazira; Adrienne K Chan; Sumeet D Sodhi; Joep J van Oosterhout Journal: PLoS One Date: 2018-05-21 Impact factor: 3.240
Authors: Emily P Hyle; Bongani M Mayosi; Keren Middelkoop; Mosepele Mosepele; Emily B Martey; Rochelle P Walensky; Linda-Gail Bekker; Virginia A Triant Journal: BMC Public Health Date: 2017-12-15 Impact factor: 3.295