title: Impact of NRTIs on lipid levels among a large HIV-infected cohort initiating antiretroviral therapy in clinical care.
abstract: OBJECTIVE
  to assess the associations between nucleoside reverse transcriptase inhibitors (NRTIs) and change in lipid levels among a large cohort of HIV-infected patients in routine clinical care initiating their first potent antiretroviral regimen.
  
  
  METHODS
  longitudinal observational cohort study from the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort.
  
  
  METHODS
  we used generalized estimating equations to examine the association between NRTIs and lipids accounting for within-patient correlations between repeated measures and key clinical and demographic characteristics including other antiretroviral medications.
  
  
  RESULTS
  among 2267 individuals who started their first antiretroviral regimen, tenofovir with emtricitabine or lamivudine was associated with lower levels for total cholesterol, low-density lipoprotein (LDL), triglycerides, non-high-density lipoprotein (HDL), and HDL, compared with other NRTI pairs in adjusted analyses. LDL levels were highest among patients receiving didanosine/lamivudine. Triglyceride levels were highest in stavudine/lamivudine users. HDL levels were highest among patients receiving didanosine/stavudine. Hepatitis C infection and younger age were also associated with lower lipid levels.
  
  
  CONCLUSIONS
  we found clinically important heterogeneity within the NRTI class of antiretroviral medications regarding their effect on lipid levels over time. Although the lipid profile of tenofovir with emtricitabine or lamivudine appeared to be less pro-atherogenic in this large longitudinal study of HIV-infected patients in routine clinical care, there was no association with beneficial HDL levels. In general, the change in lipid levels associated with most antiretroviral agents, particularly those NRTI combinations currently in common use, are relatively modest. Additional studies are needed to understand the long-term implications of these findings on cardiovascular disease risk.
authors.affiliation: University of Washington, Seattle, Washington, USA. hcrane@u.washington.edu
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Crane
authors.forename: Carl
authors.initials: C
authors.lastname: Grunfeld
authors.forename: James H
authors.initials: JH
authors.lastname: Willig
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
authors.forename: Stephen
authors.initials: S
authors.lastname: Van Rompaey
authors.forename: Richard
authors.initials: R
authors.lastname: Moore
authors.forename: Benigno
authors.initials: B
authors.lastname: Rodriguez
authors.forename: Betsy J
authors.initials: BJ
authors.lastname: Feldman
authors.forename: Michael M
authors.initials: MM
authors.lastname: Lederman
authors.forename: Michael S
authors.initials: MS
authors.lastname: Saag
authors.forename: Mari M
authors.initials: MM
authors.lastname: Kitahata
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D016049:Didanosine / Q000008:administration & dosage / Q000009:adverse effects; D050171:Dyslipidemias / Q000139:chemically induced* / Q000378:metabolism; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage / Q000009:adverse effects; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D018119:Stavudine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D018119:Stavudine; D016049:Didanosine