Association of lopinavir concentrations with plasma lipid or glucose concentrations in HIV-infected South Africans: a cross sectional study

Abstract

BackgroundDyslipidaemia and dysglycaemia have been associated with exposure to ritonavir-boosted protease inhibitors. Lopinavir/ritonavir, the most commonly used protease inhibitor in resource-limited settings, often causes dyslipidaemia. There are contradictory data regarding the association between lopinavir concentrations and changes in lipids.AimTo investigate associations between plasma lopinavir concentrations and lipid and glucose concentrations in HIV-infected South African adults.MethodsParticipants stable on lopinavir-based antiretroviral therapy were enrolled into a cross-sectional study. After an overnight fast, total cholesterol, triglycerides, and lopinavir concentrations were measured and an oral glucose tolerance test was performed. Regression analyses were used to determine associations between plasma lopinavir concentrations and fasting and 2 hour plasma glucose, fasting cholesterol, and triglycerides concentrations.ResultsThere were 84 participants (72 women) with a median age of 36 years. The median blood pressure, body mass index and waist: hip ratio were 108/72 mmHg, 26 kg/m2 and 0.89 respectively. The median CD4 count was 478 cells/mm3. Median duration on lopinavir was 18.5 months. The median (interquartile range) lopinavir concentration was 8.0 (5.2 to 12.8) μg/mL. Regression analyses showed no significant association between lopinavir pre-dose concentrations and fasting cholesterol (β-coefficient −0.04 (95% CI −0.07 to 0.00)), triglycerides (β-coefficient −0.01 (95% CI −0.04 to 0.02)), fasting glucose (β-coefficient −0.01 (95% CI −0.04 to 0.02)), or 2-hour glucose concentrations (β-coefficient −0.02 (95% CI −0.09 to 0.06)). Lopinavir concentrations above the median were not associated with presence of dyslipidaemia or dysglycaemia.ConclusionsThere was no association between lopinavir plasma concentrations and plasma lipid and glucose concentrations.

Hyperlipidaemia in HIV-Infected Patients on Lopinavir/Ritonavir Monotherapy in Resource-Limited Settings

“…Compared with other studies that used LPV/r in combination with other antiretroviral drugs, we found similar rates in India and Thailand as found in Spain (65%) [18] and Italy (82%) [19], but lower rates in the African sites than in Zimbabwe (85%) [3]. Conversely, we found a similar rate of hyperlipidaemia compared to a study in South Africa which reported a rate of 29% [20]. The differences among countries in our study were not explained by any differences among race/sites in baseline lipid levels, sex, weight, BMI, CD4 + T-cell count or HIV-1 RNA levels.…”

“…Conversely, we found a similar rate of hyperlipidemia compared to a study in South Africa which reported a rate of 29%. [20] The differences among countries in our study were not explained by any differences among race/sites in baseline lipid levels, sex, weight, BMI, CD4 count or HIV-1 RNA levels.…”

“…The 106 participants were enrolled at five sites, three in Africa (Malawi [36 participants], Tanzania [20] and South Africa [16]), Thailand (22) and India (12). Table 1 describes characteristics of participants prior to starting LPV/r monotherapy in the overall study population and by site.…”

Effectors of Hyperlipidemia Among Patients with HIV/AIDS Taking Second-line Antiretroviral Therapy Based on Registry Data

“…A study that included 1537 participants with sexually transmitted HIV/AIDS in the same area as our study showed that the prevalence of hyperlipidemia in PLWHA taking first-line ART was 19% and that in PLWHA taking second-line ART was 30.4% [ 20 ]. Other studies have reported a prevalence of hyperlipidemia among PLWHA on Lpv/r-based ART of 43.9% in Tanzania [ 21 ], 65% in Spain [ 22 ], 82% in Italy [ 23 ], and 29% in South Africa [ 24 ]. A retrospective study showed that the prevalence of hyperlipidemia among PLWHA taking Lpv/r monotherapy ranged from 31%-80% [ 25 ].…”

Metabolic Abnormalities in HIV-Infected Populations without or with Antiretroviral Therapy (ART)

“…Globally, the occurrence of dyslipidemia in HIV-seropositive patients receiving ART has been recently estimated to be between 20% and 80% [77][78][79][80][81][82][83][84][85][86][87][88][89][90]. The highest incidence of metabolic abnormality is increased serum TG concentration (hypertriglyceridemia), which is seen in the majority of HIV cases (40-80%), followed by hypercholesterolemia (10-60%), low HDL level (20-40%), and hyperglycemia or hyperinsulinemia (5-30%), whereas the lowest incidence is for diabetes (10-20%), as shown by different studies [81][82][83][84][85][86][87][88][89][90].…”