Effect of antiretroviral therapy use and adherence on the risk of hyperlipidemia among HIV-infected patients, in the highly active antiretroviral therapy era

Abstract

HIV-infected patients exposed to antiretroviral therapy (ART) have an increased risk for hyperlipidemia and cardiovascular disease. We performed a longitudinal, comprehensive, and population-based study to investigate the cumulative effect of different types of ART regimens on hyperlipidemia risk in the Taiwanese HIV/ART cohort. A total of 13,370 HIV-infected patients (2,674 hyperlipidemia and 10,696 non-hyperlipidemia patients) were recruited after matching for age, gender, and the first diagnosis date of HIV infection by using the National Health Insurance Research Database in Taiwan. Hyperlipidemia risk associated with cumulative ART use, ART adherence, and their combination was assessed. The matched hyperlipidemia group had a larger number of patients using ART and a higher incidence of comorbidities, specifically, respiratory disease and diabetes. Patients with high ART dosage and dose-dependent manner adherence, respectively, demonstrated an increased risk of hyperlipidemia. For single ART regimens, patients receiving nucleoside reverse-transcriptase inhibitors (NRTI/NRTI)- containing regimen had the highest hyperlipidemia risk, followed by protease inhibitor (PI)- containing and non-NRTI- containing regimens. For combination ART regimens, patients receiving a NRTI/NRTI + PI regimen had the highest hyperlipidemia risk. An increased cumulative drug dose was observed in patients who received the PI, NRTI/NRTI, NRTI, and NNRTI regimens in the hyperlipidemia group, when compared to the non-hyperlipidemia group. In conclusion, ART cumulative use, adherence, and regimen may affect hyperlipidemia risk among HIV-infected patients in a dose-dependent manner.

Haptoglobin phenotypes with weak antioxidant capacity increase risk factors of cardiovascular disease in Ghanaian HIV‐infected patients on highly active antiretroviral therapy

“…The significant elevations of TC, LDL‐c, and SBP, with high prevalence of hypertension suggest an increased CVD in patients on HAART. This study supports previous findings that associated hypertension and dyslipidemia with HAART administration . A unit mmol/l increase in TC in HIV‐infected individuals on HAART was found to increase the relative risk of myocardial infarction by a factor of 1.26, and the increase was attributed to dyslipidemia .…”

Evaluation of Oral Antiretroviral Drugs in Mice With Metabolic and Neurologic Complications

“…Due to the complicated ART drug combinations involved in ART treatment and the lack of an appropriate animal experimental model, determining which PIs, NRTIs, and NNRTIs may be the main cause of ART-associated lipodystrophic syndrome, metabolic consequences, and neuropsychiatric complications is a complex task. Our study demonstrates that Taiwanese HIV-1-infected patients who received an NRTI/NRTI-containing regimen had the highest hyperlipidemia risk, followed by patients receiving a PI-containing regimen ( Tsai et al, 2017 ). Amongst these NRTI/NRTI-containing regimens, the abacavir/lamivudine (Aba/Lam) and lamivudine/zidovudine (Lam/Zido) regimens were associated with the highest risk of hyperlipidemia.…”

“…The cumulative use, adherence, and treatment regimen of ART drugs used may affect the risk of development of hyperlipidemia in HIV-1-infected patients ( Jones et al, 2005 ; Anastos et al, 2007 ; Tsai et al, 2017 ). Signaling of the AMP-activated protein kinase (AMPK) protein and its downstream target, acetyl-coenzyme A carboxylase protein, are involved in lipid metabolism, and may contribute to hepatic tissue lipids and hyperlipidemia ( Zang et al, 2004 , 2006 ; Hou et al, 2008 ).…”

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“…It is not uncommon that death among opioid abusers is caused by HIV or acquired immune deficiency syndrome (AIDS) complications from unsafe injection of drugs, needle sharing, and unplanned or unprotected sex. Psychiatric and medical comorbidities with high prevalence such as diabetes 18,19 , hyperlipidemia [20][21][22] and osteoporosis 23, 24 had also become the risk factors that can result in an interaction that worsens the health problems and reduces quality of lives among PWID.…”