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First-Line Antiretroviral Therapy and Changes in Lipid Levels Over 3 years among HIV-Infected Adults in Tanzania.

Liu, E., Armstrong, C., Spiegelman, D., Chalamilla, G., Njelekela, M., Hawkins, C., Hertzmark, E., Li, N., Aris, E., Muhihi, A., Semu, H. and Fawzi, W. (2013) First-Line Antiretroviral Therapy and Changes in Lipid Levels Over 3 years among HIV-Infected Adults in Tanzania. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 56 (12). pp. 1820-8. ISSN 1537-6591

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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. 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. 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). 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.

Item Type: Article
Keywords: HIV, Adults, Antiretroviral therapy, Triglyceride, Cholesterol
Subjects: HIV > Treatment
Divisions: Muhimbili University of Health and Allied Sciences (MUHAS)
Depositing User: Mr Joseph Madata
Date Deposited: 26 Jan 2015 07:41
Last Modified: 26 Jan 2015 07:41

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