411. First-Line Antiretroviral Therapy and Lipid Profile Changes Over 24 months among HIV-infected Patients in Tanzania
Session: Poster Abstract Session: HIV - Antiretroviral Therapy
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • poster_IDSA2011.pdf (1.6 MB)
  • Background: Antiretroviral therapy (ART) has been associated with dyslipidemia, an important cardiovascular disease risk factor, in HIV-infected patients in developed countries. Data on the effect of ART on lipid changes in HIV-infected patients from resource-limited settings are scarce.

    Methods: A longitudinal study of adult (≥15 years) HIV-infected patients enrolled at 18 President's Emergency Plan for AIDS Relief (PEPFAR) - supported Management and Development for Health HIV care and Treatment clinics in Dar es Salaam, Tanzania between November 2004 - December 2010 was performed. Generalized estimating equation models were used to examine the relationship of antiretroviral (ARV) regimens (either efavirenz (EFV) or nevirapine (NVP) in combination with zidovudine (AZT) or stavudine (d4T) plus lamivudine) with lipid changes after adjusting for age, sex, body mass index, hemoglobin, CD4+ cell count, WHO HIV disease stage, alanine transaminase (ALT) level, and glucose. 

    Results: A total of  6,611 patients were included in the analysis [mean age 38 (SD 9); females 67%; mean CD4+ cell count 136 (SD 109)]. During the 24 months of treatment, triglyceride (TG) concentrations first decreased then returned to baseline levels; total cholesterol (TC), HDL and LDL cholesterol increased and were maintained at high levels. In multivariate analyses, at 6 months, TG decreased 10% (P=0.002) from baseline, with no significant difference in changes observed between NVP vs. EFV, and d4T vs. AZT containing regimens. At 24 months, patients on NVP containing regimens had smaller increases in TC than those on EFV containing regimens (15% vs. 20%, p=0.005). Patients on AZT containing regimens had smaller increases in TC compared to those on d4T containing regimens (17% vs. 20%, p=0.03).  At 24 months, HDL cholesterol increased 31% and LDL cholesterol increased 16% from baseline with no significant differences observed between ARV regimens. 

    Conclusion: In this HIV-infected Tanzanian population on first-line ART, changes in overall lipid profile similar to that observed in the US were observed, with more unfavorable changes in patients on EFV and d4T-based ART. The influence of early HDL rises on overall cardiovascular risk needs to be determined.


    Subject Category: H. HIV/AIDS and other retroviruses

    Enju Liu, PHD1, Catharina Armstrong, MD1,2, Claudia Hawkins, MD3, Eric Aris4, Chalamilla Guerino, MD4, Donna Spiegelman, PHD1 and Wafaie Fawzi, MD, MPH, DrPH1, (1)Harvard School of Public Health, Boston, MA, (2)Beth Israel Deaconess Medical Center, Boston, MA, (3)Northwestern University Feinburg School of Medicine, Chicago, IL, (4)MDH HIV/AIDS Care and Treatment Program, Dar es Salaam, Tanzania

    Disclosures:

    E. Liu, None

    C. Armstrong, None

    C. Hawkins, None

    E. Aris, None

    C. Guerino, None

    D. Spiegelman, None

    W. Fawzi, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.