title: Association of clinical and therapeutic factors with incident dyslipidemia in a cohort of human immunodeficiency virus-infected and non-infected adults: 1994-2011.
abstract: OBJECTIVE
  The aim of this study was to determine the incidence rate of dyslipidemia in a retrospective cohort of human immunodeficiency virus (HIV)-infected and non-HIV-infected adults and to evaluate the association of incident dyslipidemia with exposure to combination antiretroviral therapy (cART).
  
  
  METHODS
  The study cohort included HIV-infected individuals and a matched group of non-HIV-infected individuals served through the South Carolina Medicaid database in 1994-2011. Linkage with the HIV/AIDS surveillance database provided time-varying viro-immunological status. Time-dependent proportional hazards analysis and marginal structural models were used to assess the demographic, therapeutic, and clinical factors associated with incident dyslipidemia.
  
  
  RESULTS
  Among 13,632 adults with a median age of 39 years, the overall incidence rate per 1000 person years of dyslipidemia was higher in cART-treated compared to cART-naïve and matched non-HIV groups (24.55 vs. 14.32 vs. 23.23, respectively). Multivariable results suggested a significantly higher risk of dyslipidemia in the cART-treated HIV-infected group [adjusted hazard ratio (aHR)=1.18; 95% confidence interval (CI)=1.07-1.30] and a significantly lower risk in the cART naïve HIV-infected group (aHR=0.66; CI=0.53-0.82) compared to the control non-HIV-infected group. Marginal structural modeling suggested a significant association between incident dyslipidemia and exposure to both protease inhibitor- [adjusted rate ratio (aRR)=1.27; CI=1.08-1.49] and non-nucleoside reverse transcriptase inhibitor- (aRR=1.78; CI=1.19-2.66) based cART regimens. Pre-existing hypertension, obesity, and diabetes increased the risk of dyslipidemia, whereas hepatitis C virus, lower CD4(+) T cell count, and higher HIV viral load had a protective effect.
  
  
  CONCLUSIONS
  Incident dyslipidemia is lower in the early stages of HIV infection, but may significantly increase with cumulative exposure to cART. Viro-immunological status and underlying comorbidities have a strong association with the onset of dyslipidemia.
authors.affiliation: 1 Division of Internal Medicine, Department of Medicine, University of Mississippi School of Medicine , Jackson, Mississippi.
authors.forename: Avnish
authors.initials: A
authors.lastname: Tripathi
authors.forename: Jeanette M
authors.initials: JM
authors.lastname: Jerrell
authors.forename: Angela D
authors.initials: AD
authors.lastname: Liese
authors.forename: Jiajia
authors.initials: J
authors.lastname: Zhang
authors.forename: Ali A
authors.initials: AA
authors.lastname: Rizvi
authors.forename: Helmut
authors.initials: H
authors.lastname: Albrecht
authors.forename: Wayne A
authors.initials: WA
authors.lastname: Duffus
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology; D015331:Cohort Studies; D050171:Dyslipidemias / Q000097:blood* / Q000150:complications*; D062665:Epidemiological Monitoring; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000097:blood* / Q000150:complications*; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013022:South Carolina; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents