title: Hyperlipidaemia in HIV-infected patients on lopinavir/ritonavir monotherapy in resource-limited settings.
abstract: Cardiovascular disease (CVD) is an emerging concern for HIV-infected patients. Hyperlipidaemia is a risk factor for CVD and a complication of protease-inhibitor-based antiretroviral therapy, but little is known about its incidence and risk factors in treated patients in resource-limited settings (RLS).
  
  
  
  We conducted a secondary analysis of ACTG A5230 trial in which HIV-infected adults from India, Malawi, Tanzania, Thailand and South Africa, with virological relapse on first-line therapy were initiated on lopinavir/ritonavir (LPV/r) monotherapy. Hyperlipidaemia was a grade 2+ elevated fasting total cholesterol (FTC≥240 mg/dl) or fasting triglycerides (FTG≥500 mg/dl) or calculated low-density lipoprotein cholesterol (LDL≥160 mg/dl) based on measurements at weeks 12, 24, 48, 68 and 104. We evaluated factors potentially associated with quantitative lipid changes from baseline to week 12. These were age, sex, race, site and baseline body mass index, CD4+T-cell count, HIV-1 RNA level and lipids.
  
  
  
  106 participants without hyperlipidaemia at baseline started LPV/r; median age 39 years, 68% Black African, 55% female. The cumulative incidence of hyperlipidaemia at week 104 was 48% (95% CI 36, 58%). At week 12, there were significant mean increases from baseline in FTC (17 mg/dl, P<0.001) and FTG (104 mg/dl, P<0.001). In multivariable analysis, higher baseline FTC (P=0.044), FTG (P=0.025), Thai (P<0.001) or Indian sites (P=0.020) versus African sites were associated with increased risk of hyperlipidaemia.
  
  
  
  In HIV-infected adults in RLS initiating LPV/r, hyperlipidaemia was common. Baseline lipid measurements and routine monitoring should be recommended in individuals starting LPV/r-based treatments with borderline high lipids.
authors.affiliation: The University of North Carolina Project-Lilongwe, Lilongwe, Malawi.
authors.forename: Mitch M
authors.initials: MM
authors.lastname: Matoga
authors.affiliation: The University of North Carolina Project-Lilongwe, Lilongwe, Malawi.|The Department of Medicine, Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
authors.affiliation: Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health, Boston, MA, USA.
authors.forename: Evgenia
authors.initials: E
authors.lastname: Aga
authors.affiliation: Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health, Boston, MA, USA.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Ribaudo
authors.affiliation: YRG Centre for AIDS Research and Education, Chennai, India.
authors.forename: Nagalingeswaran
authors.initials: N
authors.lastname: Kumarasamy
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: John
authors.initials: J
authors.lastname: Bartlett
authors.affiliation: Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health, Boston, MA, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hughes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers; D018791:CD4 Lymphocyte Count; D002986:Clinical Trials as Topic; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D017320:HIV Protease Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D006949:Hyperlipidemias / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D015994:Incidence; D008055:Lipids / Q000097:blood; D061466:Lopinavir / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D012307:Risk Factors; D019438:Ritonavir / Q000009:adverse effects* / Q000627:therapeutic use; D019562:Viral Load; D055815:Young Adult
chemical_list: D015415:Biomarkers; D017320:HIV Protease Inhibitors; D008055:Lipids; D061466:Lopinavir; D019438:Ritonavir