Assessment of dyslipidemia and associated factors in patients receiving Efavirenz based Highly Active Antiretroviral Therapy among Human Immunodeficiency Virus only and Human Immunodeficiency Virus-Tuberculosis coinfected patients in Addis Ababa.
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Date
2019-07
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Addis Abeba University
Abstract
Although the introduction of Highly Active Antiretroviral Therapy (HAART) has greatly reduced
the morbidity and mortality associated with Human Immunodeficiency Virus (HIV), dyslipidemia
and increased cardiovascular risk are among the significant adverse drug reactions with long-term
HAART. Among other antiretroviral medications, Efavirenz based antiretroviral therapy is
implicated in the development of dyslipidemia. With this intent this study aimed at assessing
dyslipidemia and associated factors in patients receiving Efavirenz based highly active
antiretroviral therapy among HIV only and TB-HIV co-infected patients. The study was conducted
on non-fasting stored plasma specimens that had already been collected under a broad clinical
research named “The TB-HIV Pharmagene Study in Ethiopia, a sub-Saharan African country”.
HIV infected (i.e. Arm 1) patients received EFV-based HAART (Zidovudine (ZDV), Stavudine
(d4T) or Tenofovir (TDF) with Lamivudine (3TC) as NRTI back bone), and TB-HIV co-infected
(i.e. Arm2) patients received Rifampicin based anti-TB therapy in addition to EFV-based HAART.
Plasma High Density Lipoprotein-c (HDL), Low Density Lipoprotein-c (HDL), Triglyceride (TG)
and Total Cholesterol (TC) concentrations were determined at baseline, and after 4 and 16 weeks
of initiation of HAART in both arms. Total Cholesterol to High Density Lipoprotein-c ratio was
also calculated. 89 stored biologic specimens were used where 30 were from Arm 1 and 59 were
from Arm 2. The majority of specimens were from females (76.7% and 55.9% in arm 1 and 2,
respectively). The mean age was 35.6 and 33.9 in arm 1 and 2, respectively and the two arms were
not significantly different in terms of socio-demographic, baseline clinical, and laboratory
characteristics except for Body Mass Index and cotrimoxazole prophylaxis therapy. At baseline,
only the values for TG were significantly different between the two arms (158 mg/dL in Arm1 and
131 mg/dL in Arm 2 (p <0.001). After 16 weeks of initiation of EFV-based HAART, the mean
(SD) percentage change from the baseline was significant for LDL-c [Arm 1- 61.5% (20.32) Vs.
Arm 2- 43.6% (23.4); p=0.001], TC [Arm 1- 54.1% (38.7) Vs Arm 2- 36.6% (25.4); p=0.01], and
TG [Arm 1- 10.6% (11.8) Vs. Arm 2- 21.9% (19.3); p=0.004]. But it was not significant for HDLc
[Arm
1-
43.6%
(16.9)
Vs.
Arm
2-
47.3%
(29.3);
p=0.52].
Compared
to
baseline,
the
proportion
of
patients with high LDL-c, hypertriglyceridemia, and hypercholesterolemia had increased by
23.3%, 33.1%, and 33.3% for Arm 1 and 23.7%, 10.4%, and 32.2% for Arm 2, respectively,
whereas, low HDL-c and high TC:HDL-c ratio had decreased by 50% and 3.3% in Arm 1 and
70% and 18.6% for Arm 2, respectively, with no significant difference between the arms. The
prevalence of dyslipidemia was 83.3% and 62.7% in arm 1 and 2, respectively. None of the socio-
demographic and baseline clinical and laboratory parameters were found to be associated with
dyslipidemia in both arms. Even though EFV-based HAART was associated with a significant
decrease in low HDL-c and high TC:HDL-c ratio, there were also a significant increase in the
proportion of patients with high LDL-c, TG, and TC which necessitates the determination of
baseline and follow-up lipid profile of patients who are going to start on this medication.
Description
Keywords
Dyslipidemia, HIV/AIDS, HIV-TB co-infection, Antiretroviral therapy, Ethiopia