Improvement in lipid profiles over 6 years of follow-up in adults with AIDS and immune reconstitution.
OBJECTIVE
The aim of the study was to evaluate long-term changes in lipids and to assess other coronary heart disease (CHD) risk factors in highly experienced AIDS patients with immune reconstitution, and to examine their association with antiretroviral therapy (ART).


METHODS
We evaluated 433 AIDS patients with prior severe immunosuppression and ART-based immune reconstitution, followed in a multicentre prospective observational study between 2000 and 2006. We estimated the prevalence at entry of hypercholesterolaemia and metabolic syndrome, and 10-year CHD risks. Trends in total cholesterol (TC), triglycerides (TG) and high-density lipoprotein (HDL) cholesterol were evaluated over time, and use of specific ART drugs at each study visit was assessed using mixed effect models, adjusting for CHD risk factors and use of lipid-lowering agents.


RESULTS
At entry to observational follow-up, 28% of the 433 subjects had hypercholesterolaemia and 15% had a predicted 10-year CHD risk above 20%. Average TC and fasting TG levels declined over the follow-up period (median=5.8 years), and these declines were associated with increased use of physician-prescribed lipid-lowering agents and changes in ART regimens. After adjustment for CHD risk factors, TC and TG levels were significantly higher for those on ritonavir-boosted protease inhibitors and those on nonnucleoside reverse transcriptase inhibitors (NNRTIs), particularly efavirenz, than for other patients.


CONCLUSIONS
Abnormalities in serum lipids were common at baseline but became less so over time, and this improvement was associated with increased use of lipid-lowering agents and selection of ART agents with less deleterious effects on lipids.
Williams
Pl
P
Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA 02115, USA. paige@sdac.harvard.edu
Wu
Jw
J
Cohn
Se
S
Koletar
Sl
S
McCutchan
Ja
J
Murphy
Rl
R
Currier
Js
J
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D000328:Adult; D000480:Alkynes; D044966:Anti-Retroviral Agents / Q000009:adverse effects*; D048588:Benzoxazines / Q000009:adverse effects; D050218:Body Fat Distribution; D002318:Cardiovascular Diseases / Q000139:chemically induced; D003327:Coronary Disease / Q000453:epidemiology*; D003521:Cyclopropanes; D004359:Drug Therapy, Combination; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000139:chemically induced / Q000453:epidemiology*; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D054019:Immune Reconstitution Inflammatory Syndrome / Q000150:complications*; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology*; D008875:Middle Aged; D016896:Treatment Outcome
D000480:Alkynes; D044966:Anti-Retroviral Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D000960:Hypolipidemic Agents; C098320:efavirenz