Longitudinal analysis of the associations between antiretroviral therapy, viraemia and immunosuppression with lipid levels: the D:A:D study

David A Kamara, Colette Smith, Lene Ryom Nielsen, Peter Reiss, Martin Rickenbach, Andrew Phillips, Amanda Mocroft, Stephan De Wit, Matthew Law, Antonella d'Arminio Monforte, Francois Dabis, Christian Pradier, Jens D Lundgren, Caroline Sabin

    20 Citationer (Scopus)

    Abstract

    BACKGROUND: Antiretroviral (ART) drugs have been associated with higher triglycerides (TG), higher total cholesterol (TC) and lower high density lipoprotein cholesterol (HDL-C) levels. Associations between lipid levels with HIV viraemia and immunosuppression in the presence of ART remain unclear.

    METHODS: Participants from the D:A:D study with at least one TG/TC/HDL-C measurement were included. Linear mixed effect models were used to determine the association of ART, viral load (VL), nadir and current CD4 count and previous AIDS diagnosis with lipids.

    RESULTS: Of 49,717 participants, 90%, 92% and 80% contributed at least one TG/TC/HDL-C measurement (median follow-up; 6.8, 6.8 and 5.0 years), respectively. Predicted mean (95% confidence interval (CI)) baseline levels for TG, TC and HDL-C (mmol/l), were 2.10 (2.05-2.14), 4.94 (4.91-4.98) and 1.08 (1.07-1.10), respectively.Lopinavir was associated with the worst TG profile, (27.2% higher levels compared to atazanavir; 25.2%, 29.2%), and darunavir had a similar profile as atazanavir. The nucleoside pair, lamivudine/tenofovir was associated with the most favourable TG profile (-2.8%; -3.5%, -2.0%) compared to emtricitabine/tenofovir, whereas lamivudine/abacavir (+10.2%; +9.3%, +11.2%) and lamivudine/stavudine (+8.0%; +6.9%, +9.0%), were associated with the worst. Raltegravir was associated with lower TG (-5.2%; -6.4%, -3.9%), and nevirapine had a more favourable HDL-C profile (+11.3%; +10.8%, +11.7%) than efavirenz (+5.3%; 5.0%, 5.7%), compared to atazanavir. Higher VLs were associated with lower TG/TC/HDL-C, whereas higher CD4 counts were associated with higher TG/TC/HDL-C.

    CONCLUSIONS: TG, TC and HDL-C levels, which generally improved over time, are dependent on ART, viraemia and, to a lesser extent, immunosuppression.

    OriginalsprogEngelsk
    TidsskriftAntiviral Therapy
    Vol/bind21
    Sider (fra-til)495-506
    ISSN1359-6535
    DOI
    StatusUdgivet - 26 apr. 2016

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