title: Impact of antiretroviral therapy on serum lipoprotein levels and dyslipidemias: a systematic review and meta-analysis.
abstract: BACKGROUND
  Antiretroviral drugs increase biosynthesis and reduce hepatic clearance of serum cholesterol. It is thus important to evaluate the impact of antiretroviral treatment on serum lipoprotein levels and the risk of dyslipidemia.
  
  
  METHODS
  We searched EMBASE and PubMed for articles comparing lipid profiles between HIV-infected adult patients naïve and exposed to antiretroviral therapy (ART). Eligible studies were pooled by performing random-effects meta-analyses of mean serum lipoprotein levels and prevalence estimates of dyslipidemias.
  
  
  RESULTS
  51 observational studies comprising 37,110 patients were included in the meta-analyses. ART-exposed patients had significantly higher concentrations of total cholesterol (45 studies, mean difference [MD]=29.4mg/dL, 95% confidence interval [CI] 26.5 to 32.4, I(2)=82.2%), low density lipoprotein-cholesterol (37 studies, MD=14.9mg/dL, 95% CI 11.2 to 18.5, I(2)=86.1%), and triglycerides (43 studies, MD=46.8mg/dL, 95% CI 37.8 to 55.8, I(2)=97.1%), compared with ART-naïve patients. The risks of hypercholesterolemia (25 studies, pooled odds ratio [OR] 3.8, 95% CI 3.1 to 4.7, I(2)=60.0%) and hypertriglyceridemia (21 studies, OR 2.2, 95% CI 1.7 to 2.9, I(2)=81.7%) were also significantly higher among ART-exposed patients, compared with ART-naïve patients.
  
  
  CONCLUSIONS
  Antiretroviral therapy is significantly associated with increase in serum lipid levels and increased risk of dyslipidemia. Whether or not these associations are causal should be investigated by future studies.
authors.affiliation: Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK. Electronic address: C.U.Nduka@warwick.ac.uk.
authors.forename: Chidozie
authors.initials: C
authors.lastname: Nduka
authors.affiliation: Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Sarki
authors.affiliation: Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Olalekan
authors.initials: O
authors.lastname: Uthman
authors.affiliation: Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg.
authors.forename: Saverio
authors.initials: S
authors.lastname: Stranges
mesh_terms: D044966:Anti-Retroviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D050171:Dyslipidemias / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology; D014943:Global Health; D006678:HIV; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008074:Lipoproteins / Q000097:blood*; D012307:Risk Factors
chemical_list: D044966:Anti-Retroviral Agents; D008074:Lipoproteins
keywords: Antiretroviral therapy; Dyslipidemias; HIV; Lipoproteins