TY - JOUR
T1 - Longitudinal analysis of the associations between antiretroviral therapy, viraemia and immunosuppression with lipid levels
T2 - the D:A:D study
AU - Kamara, David A
AU - Smith, Colette
AU - Nielsen, Lene Ryom
AU - Reiss, Peter
AU - Rickenbach, Martin
AU - Phillips, Andrew
AU - Mocroft, Amanda
AU - De Wit, Stephan
AU - Law, Matthew
AU - Monforte, Antonella d'Arminio
AU - Dabis, Francois
AU - Pradier, Christian
AU - Lundgren, Jens D
AU - Sabin, Caroline
PY - 2016/4/26
Y1 - 2016/4/26
N2 - 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.
AB - 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.
U2 - 10.3851/IMP3051
DO - 10.3851/IMP3051
M3 - Journal article
C2 - 27114439
SN - 1359-6535
VL - 21
SP - 495
EP - 506
JO - Antiviral Therapy
JF - Antiviral Therapy
ER -