Assessment of Lipid Profile in HIV Infected Patients Using the First Line Antiretroviral Drugs at Muhimbili National Hospital

Abstract

Background: The use of antiretroviral therapy has been reported to cause dyslipidemia and increased risk of cardiovascular diseases (CVD) in HIV-infected patients in industrialized countries. The effects of antiretroviral drugs (ARVs) on lipid metabolism among sub-Saharan Africans, for whom access to antiretroviral therapy is expanding, remain largely unknown. Various factors have been found to be associated with poor lipid profiles. Therefore assessement of lipid profile as a marker for CVD in HIV-infected patients, is important in order to identify factors that are most likely to cause this problem among ARVs users. Identification of these factors is important in order to formulate appropriate interventions that will result in improved lipid profile and hence prevention of CVD among patients. Objectives: The aim of this study was to determine the prevalence of dyslipidemia in HIV-infected patients using the first line ARVs triple regimen. The magnitude of the prevalence will help in addressing factors associated with dyslipidemia and discuss the treatment of choice for individuals experiencing dyslipidemia while using ARVs triple regimen. Methodology: A hospital based cross - sectional study was conducted among HIV-infected patients aged 15 years and above attending Care and Treatment Clinic (CTC) at Muhimbili National Hospital (MNH). A systematic random sample of 231 patients using first line triple therapy of ARVs for at least 24 weeks were enrolled over a period of 3 months from January 2014 to March 2014 to participate in the study. Patients data were collected from patient identification card (CTC1) & patient record form (CTC2 ) and interviews were done using a structured questionaire. Blood samples from patients was collected during their regular visits at the CTC and assayed for total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL), low density lipoprotein (LDL) cholesterol and CD4 cell counts. Data were described using means for continuous variables and proportions for categorical variables. Significance testing of proportions was carried out by using Chi-square test, where a probability (P) of less than 0.05 was considered to be statistically significant. Any factor with p- value of less or equal to 0.2 was considered for binary logistic regression which was used to study the independent factors predicting poor lipid parameters. Results: Majority of patients (75.9%) were females. The mean age of the patients was 42 ± 9.19 years and their median CD4 cell count was 346 cells/mm3 (2-2600), after a median duration of 24 months (6-287) on ARVs. Proportion of patients using various first line ARVs, included 42.4%, 33.8%, 19.9% and 3.9% for zidovudine /lamivudine/efavirenz (AZT/3TC/EFV), zidovudine/lamivudine/nevirapine (AZT/3TC/NVP), tenofovir/emtricitabine/efavirenz (TDF/FTC/EFV) and tenofovir/lamivudine/efavirenz (TDF/3TC/EFV) respectively. The overall prevalence of dyslipidemia was 77.5%, the prevalence of hypercholesterolemia, hypertriglyceridemia, low HDLc and , increased LDLc were 53.5%, 29.6%, 16.5%, and 59.8% respectively. Sex, age, CD4 cell count levels, body mass index (BMI) and duration of more than two years for ARVs use was significantly associated with poor lipid profiles. Conclusion: Overall, the findings from the current study indicate that there is high prevalence of dyslipidemia among HIV-infected patients using first line ARVs attending CTC at MNH. We recommend that the National AIDS Control Program should institute mandatory laboratory monitoring of serum lipids for HIV infected patients at baseline before initiation of ARVs treatment and lipid profile monitoring during therapy.