title: First-line antiretroviral therapy and changes in lipid levels over 3 years among HIV-infected adults in Tanzania.
abstract: BACKGROUND
  With the rapid rollout of antiretroviral therapy (ART) in sub-Saharan Africa (SSA), there has been an increasing concern about cardiovascular risks related to ART. However, data from human immunodeficiency virus (HIV)-infected populations from this region are very limited.
  
  
  METHODS
  Among 6385 HIV-infected adults in Dar es Salaam, Tanzania, we investigated the nonfasting lipid changes over 3 years following ART initiation and their associations with different first-line ART agents that are commonly used in SSA.
  
  
  RESULTS
  In the first 6 months of ART, the prevalence of dyslipidemia decreased from 69% to 54%, with triglyceride (TG) decreasing from 127 mg/dL to 113 mg/dL and high-density lipoprotein (HDL) cholesterol increasing from 39 mg/dL to 52 mg/dL. After 6 months, TG returned to its baseline level and increased to 139 mg/dL at 3 years; total cholesterol and low-density lipoprotein cholesterol continued to increase whereas HDL cholesterol leveled off. The prevalence of dyslipidemia increased to 73% after a 3-year follow-up. In multivariate analyses, patients on zidovudine-containing regimens had a greater reduction in TG levels at 6 months (-16.0 vs -6.3 mg/dL), and a lower increase at 3 years compared to patients on stavudine-containing regimens (2.1 vs 11.7 mg/dL, P < .001); patients on nevirapine-based regimens had a higher increase in HDL cholesterol levels at 3 years compared to those on efavirenz-based regimens (13.6 vs 9.5 mg/dL, P = .01).
  
  
  CONCLUSIONS
  Our findings support the latest World Health Organization guidelines on the substitution of stavudine in first-line ART in resource-limited settings, and provide further evidence for selection of lipid-friendly ART for patients in SSA.
authors: Department of Global Health and Population, Harvard School of Public Health, 1633 Tremont St, Rm 106, Boston, MA 02120, USA. eliu@hsph.harvard.edu
authors: Enju
authors: E
authors: Liu
authors: Catharina
authors: C
authors: Armstrong
authors: Donna
authors: D
authors: Spiegelman
authors: Guerino
authors: G
authors: Chalamilla
authors: Marina
authors: M
authors: Njelekela
authors: Claudia
authors: C
authors: Hawkins
authors: Ellen
authors: E
authors: Hertzmark
authors: Nan
authors: N
authors: Li
authors: Eric
authors: E
authors: Aris
authors: Alfa
authors: A
authors: Muhihi
authors: Helen
authors: H
authors: Semu
authors: Wafaie
authors: W
authors: Fawzi
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D050171:Dyslipidemias / Q000097:blood* / Q000821:virology*; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy*; D006801:Humans; D008055:Lipids / Q000097:blood*; D008137:Longitudinal Studies; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D013636:Tanzania
chemical_list: D044966:Anti-Retroviral Agents; D008055:Lipids
keywords: HIV; adults; antiretroviral therapy; cholesterol; triglyceride