Current Efavirenz (EFV) or ritonavir-boosted lopinavir (LPV/r) use correlates with elevate markers of atherosclerosis in HIV-infected subjects in Addis Ababa, Ethiopia.
BACKGROUND
HIV patients on antiretroviral therapy have shown elevated incidence of dyslipidemia, lipodystrophy, and cardiovascular disease (CVD). Most studies, however, focus on cohorts from developed countries, with less data available for these co-morbidities in Ethiopia and sub-Saharan Africa.


METHODS
Adult HIV-negative (n = 36), treatment naïve (n = 51), efavirenz (EFV)-treated (n = 91), nevirapine (NVP)-treated (n = 95), or ritonavir-boosted lopinavir (LPV/r)-treated (n=44) subjects were recruited from Black Lion Hospital in Addis Ababa, Ethiopia. Aortic pressure, augmentation pressure, and pulse wave velocity (PWV) were measured via applanation tonometry and carotid intima-media thickness (cIMT) and carotid arterial stiffness, and brachial artery flow-mediated dilation (FMD) were measured via non-invasive ultrasound. Body mass index, waist-to-hip circumference ratio (WHR), skinfold thickness, and self-reported fat redistribution were used to quantify lipodystrophy. CD4+ cell count, plasma HIV RNA levels, fasting glucose, total-, HDL-, and LDL-cholesterol, triglycerides, hsCRP, sVCAM-1, sICAM-1, leptin and complete blood count were measured.


RESULTS
PWV and normalized cIMT were elevate and FMD impaired in EFV- and LPV/r-treated subjects compared to NVP-treated subjects; normalized cIMT was also elevated and FMD impaired in the EFV- and LPV/r-treated subjects compared to treatment-naïve subjects. cIMT was not statistically different across groups. Treated subjects exhibited elevated markers of dyslipidemia, inflammation, and lipodystrophy. PWV was associated with age, current EFV and LPV/r used, heart rate, blood pressure, triglycerides, LDL, and hsCRP, FMD with age, HIV duration, WHR, and glucose, and cIMT with age, current EFV use, skinfold thickness, and blood pressure.


CONCLUSIONS
Current EFV- or LPV/r-treatment, but not NVP-treatment, correlated with elevated markers of atherosclerosis, which may involve mechanisms distinct from traditional risk factors.
The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, United States of America; The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States of America; The Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, United States of America.
Rudolph L
RL
Gleason
The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, United States of America.
Alexander W
AW
Caulk
Department of Biochemistry, Medical Faculty, Addis Ababa University, Addis Ababa, Ethiopia.
Daniel
D
Seifu
The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States of America.
Ivana
I
Parker
The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States of America.
Brani
B
Vidakovic
Department of Internal Medicine, Medical Faculty, Addis Ababa University, Addis Ababa, Ethiopia.
Helena
H
Getenet
Department of Radiology, Medical Faculty, Addis Ababa University, Addis Ababa, Ethiopia.
Getachew
G
Assefa
Department of Internal Medicine, Medical Faculty, Addis Ababa University, Addis Ababa, Ethiopia.
Wondwossen
W
Amogne
D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000097:blood* / Q000150:complications / Q000821:virology; D048588:Benzoxazines / Q000627:therapeutic use*; D015415:Biomarkers / Q000032:analysis; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000378:metabolism; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003521:Cyclopropanes; D005002:Ethiopia; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000254:growth & development; D006339:Heart Rate; D006801:Humans; D008060:Lipodystrophy / Q000097:blood* / Q000150:complications / Q000821:virology; D061466:Lopinavir / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D019829:Nevirapine / Q000627:therapeutic use; D063177:Pulse Wave Analysis; D019438:Ritonavir / Q000627:therapeutic use*; D014280:Triglycerides / Q000097:blood
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D003521:Cyclopropanes; D014280:Triglycerides; D061466:Lopinavir; D002097:C-Reactive Protein; D019829:Nevirapine; C098320:efavirenz; D019438:Ritonavir