Evolution of blood lipids and risk factors of dyslipidemia among people living with human immunodeficiency virus who had received first-line antiretroviral regimens for 3 years in Shenzhen

Abstract

Background Lipid abnormalities are prevalent among people living with human immunodeficiency virus (HIV) (PLWH) and contribute to increasing risk of cardiovascular events. This study aims to investigate the incidence of dyslipidemia and its risk factors in PLWH after receiving different first-line free antiretroviral regimens. Methods PLWH who sought care at the Third People's Hospital of Shenzhen from January 2014 to December 2018 were included, and the baseline characteristics and clinical data during the follow-up were collected, including total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). The risk factors of dyslipidemia after antiretroviral therapy were analyzed with the generalized estimating equation model. Results Among the 7623 PLWH included, the mean levels of TC, HDL-C and LDL-C were 4.23 ± 0.85 mmol/L, 1.27 ± 0.29 mmol/L and 2.54 ± 0.65 mmol/L, respectively, and the median TG was 1.17 (IQR: 0.85−1.68) mmol/L. Compared with that in PLWH receiving tenofovir disoproxil fumarate (TDF) + lamivudine (3TC) + ritonavir-boosted lopinavir (LPV/r), zidovudine (AZT) + 3TC + efavirenz (EFV), and AZT + 3TC + LPV/r, the incidence of dyslipidemia was lower in PLWH receiving TDF + 3TC + EFV. In multivariate analysis, we found that the risks of elevations of TG, TC, and LDL-C were higher with TDF + 3TC + LPV/r (TG: odds ratio [OR] = 2.82, 95% confidence interval [CI]: 2.55−3.11, P < 0.001; TC: OR = 1.24, 95% CI: 1.14−1.35, P < 0.001; LDL: OR = 1.06, 95% CI: 1.00−1.12, P = 0.041), AZT + 3TC + EFV (TG: OR = 1.41, 95% CI: 1.28−1.55, P < 0.001; TC: OR = 1.43, 95% CI: 1.31−1.56, P < 0.001; LDL: OR = 1.18, 95% CI: 1.12−1.25, P < 0.001), and AZT + 3TC + LPV/r (TG: OR = 3.08, 95% CI: 2.65−3.59, P < 0.001; TC: OR = 2.40, 95% CI: 1.96−2.94, P < 0.001; LDL: OR = 1.52, 95% CI: 1.37−1.69, P < 0.001) than with TDF + 3TC + EFV, while treatment with TDF + 3TC + LPV/r was less likely to restore HDL-C levels compared with TDF + 3TC + EFV (OR = 0.95, 95% CI: 0.92−0.97, P < 0.001). In addition to antiretroviral regimens, antiretroviral therapy duration, older age, overweight, obesity and other traditional factors were also important risk factors for dyslipidemia. Conclusion The incidence of dyslipidemia varies with different antiretroviral regimens, with TDF + 3TC + EFV having lower risk for dyslipidemia than the other first-line free antiretroviral regimens in China.

Higher Risk of Dyslipidemia With Coformulated Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Alafenamide than Efavirenz, Lamivudine, and Tenofovir Disoproxil Fumarate Among Antiretroviral-Naive People Living With HIV in China

“…As previously reported, the effect of TDF + 3TC + EFV had a relatively small impact on dyslipidemia among PLWH in China. 25 This study also confirmed that TDF + 3TC + EFV was mainly associated with an increased TG level. E/C/F/TAF exposure was associated with increased TC, TG, and LDL-C levels, which was consistent with the results of the study by Huang et al 26 It is worth noting that TC, TG, and LDL-C in E/C/F/TAF group were all higher than those in TDF + 3TC + EFV group at 3, 6, 9, and 12 months of ART initiation.…”

The effects of ART on the dynamics of lipid profiles in Chinese Han HIV-infected patients: comparison between NRTI/NNRTI and NRTI/INSTI

“…Even though there was a wide range of confounding factors and limited sample size in this study, advanced methods and sensitivity analyses were used to obtain robust analysis results. Our findings confirm and extend the results from previous observational studies, which showed that age, gender, BMI, CD4 count, and ART duration were the predictors of unfavorable lipid profiles alterations in patients on ART ( 24 , 25 , 30 , 31 ).…”

Switching from efavirenz to elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide reduces central nervous system symptoms in people living with HIV

“…The median CNS toxicity score at baseline was estimated at 13 (IQR: 11-15). Compared to the baseline CNS toxicity score, the median CNS toxicity score at week 12 (which became 10 [IQR: [8][9][10][11][12]) significantly decreased (compared with baseline, P < 0.001) and remained stable at weeks 24 (9 [IQR: 7-12], P < 0.001) and 48 (9 [IQR: 7-11], P < 0.001).…”

“…[3] A significant number of PI-related dyslipidemias have also been reported. [7][8][9][10] As such, we can note the elevation of lipid parameters like total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG), which are recognized risk factors for cardiovascular disease. [10] The fixed-dose combination, oral tablet, of elvitegravir/ cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/ TAF) for HIV treatment was first approved by the US Food and Drug Administration in 2015 [11] and then officially introduced in China for the first time in 2018.…”

“…Before the availability of potent integrase inhibitors, HIV-positive individuals who do not tolerate EFV were treated with lopinavir/ritonavir (LPV/r), which was the only NFATP-sponsored protease inhibitors (PIs) freely provided by the Chinese government [3] . A significant number of PI-related dyslipidemias have also been reported [7–10] . As such, we can note the elevation of lipid parameters like total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG), which are recognized risk factors for cardiovascular disease [10] …”