Efavirenz and ritonavir-boosted lopinavir use exhibited elevated markers of atherosclerosis across age groups in people living with HIV in Ethiopia.
HIV patients on highly-active antiretroviral therapy (HAART) have shown elevated incidence of dyslipidemia, lipodystrophy, and markers of cardiovascular disease. Evidence is beginning to emerge that implicates efavirenz (EFV) as a potential mediator of early on-set cardiovascular disease.



Pediatric and adult HIV-infected HAART-naïve, EFV-treated, nevirapine (NVP)-treated, and ritonavir-boosted lopinavir (LPV/r)-treated subjects were recruited from Black Lion Hospital in Addis Ababa, Ethiopia. Pulse wave velocity (PWV), carotid intima-media thickness (cIMT), carotid arterial stiffness, brachial artery flow-mediated dilation (FMD), body mass index, waist-to-hip circumference ratio, and skinfold thickness were measured. CD4+ cell count, fasting glucose, lipoprotein profiles and triglycerides were also determined. Results were segmented into pediatric (6-17 years of age), young adults (25-39 years old) and older adults (40-60 years old).



PWV was generally elevated in EFV- and LPV/r-treated subjects compared to NVP-treated subjects across age groups. cIMT was elevated in EFV- and LPV/r-treated compared to NVP-treated older adults and in EFV-treated compared to HAART-naïve older adults. FMD was impaired in EFV- and LPV/r-treated compared to HAART-naïve younger adults, in EFV-treated compared to NVP-treated young and older adults, and in LPV/r-treated compared to NVP-treated older adults. Differences in lipoprotein profiles and skinfold thickness with HAART regimen were observed in pediatric and young adults, but less so in older adults.



Whereas LPV/r and other protease inhibitors have long been recognized as mediators of HIV/HAART-associated atherosclerosis, this report supports the emerging evidence that EFV may also mediate cardiovascular disease in people living with HIV on HAART.
The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA; The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA; Department of Biochemistry, Addis Ababa University, Addis Ababa, Ethiopia. Electronic address: rudy.gleason@me.gatech.edu.
Rudolph L
RL
Gleason
The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
Alexander W
AW
Caulk
Department of Biochemistry, Addis Ababa University, Addis Ababa, Ethiopia.
Daniel
D
Seifu
Emory University School of Medicine, Atlanta, GA, USA.
Julia C
JC
Rosebush
The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
Alyssa M
AM
Shapiro
The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
Matthew H
MH
Schwartz
Medical University of South Carolina, Charleston, SC, USA.
Allison Ross
AR
Eckard
Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
Wondwossen
W
Amogne
Department of Pediatrics and Child Health, Addis Ababa University, Addis Ababa, Ethiopia.
Workeabeba
W
Abebe
D000293:Adolescent; D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D050197:Atherosclerosis / Q000097:blood* / Q000139:chemically induced; D048588:Benzoxazines / Q000009:adverse effects* / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D059168:Carotid Intima-Media Thickness; D002648:Child; D003521:Cyclopropanes; D005002:Ethiopia; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy; D006801:Humans; D008055:Lipids / Q000097:blood; D061466:Lopinavir / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis; D019438:Ritonavir / Q000009:adverse effects* / Q000627:therapeutic use; D055815:Young Adult
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D015415:Biomarkers; D003521:Cyclopropanes; D008055:Lipids; D061466:Lopinavir; C098320:efavirenz; D019438:Ritonavir
Antiretroviral therapy; Arterial stiffness; Carotid intima-media thickness; Endothelial dysfunction; Non-AIDS related comorbidities