Risk factors and longitudinal changes of dyslipidemia among adult Chinese HIV-1 Patients Receiving Antiretroviral Therapy

Abstract

Background Despite an apparent decline in mortality of HIV-infected individuals due to the broad utilization of antiretroviral therapy (ART), life-long treatment is required accompanying with various metabolic abnormalities. Data about the epidemiology and the dynamic change of dyslipidemia in HIV-1 patients receiving antiretroviral therapy was restricted in Asian countries. The purpose was to explore the specific situation of dyslipidemia in adult Chinese HIV-1 Patients upon a multicenter clinical trial. Methods We conducted a retrospective cross-sectional analysis on patients enrolled in two large multicenter clinical trials across China and patients followed in the clinic of Peking Union Medical College Hospital (PUMCH). Demographic data and clinical parameters were collected, risk factors and longitudinal changes of lipid profiles under different clinical settings associated with HIV-1 infection were analyzed. The definition of dyslipidemia was made based upon the National Cholesterol Education Program, Adult Treatment Panel (NCEP-ATP) III guidelines. Results A total of 1942 patients were enrolled. The median follow-up was 6 years. At baseline, the concentrations of total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were 4.1 ± 0.96 mmol/L, 1.24 (interquartile ranges [IQR] 0.87–1.8) mmol/L, 1.11 ± 0.33 and 2.38 ± 0.78 mmol/L, respectively. The rate of hypercholesterolemia, hyperglyceridemia, high LDL-C and low HDL-C were 11.38%, 28.16%, 45.66% and 9.29%, respectively. The overall prevalence of dyslipidemia was 69.3%, which raised to 84.3% after antiretroviral therapy, substantially higher. Risk factors of CD4/CD8 ratio less than 0.3 and viral load over 105 copies/mL for all types of dyslipidemia as well as a negative correlation between HDL-C concentration and CD8 + CD38 + percentage were found. Besides, regimens including efavirenz (EFV) and tenofovir (TDF) performed better lipid profiles. Longitudinal analysis revealed that both the rate of abnormal lipid indexes and concentration of lipid changed steeply in the first 6 months after ART initiation. Conclusions The prevalence of dyslipidemia was high in HIV-1 patients and elevated after antiretroviral therapy, mainly represented as high TG and low HDL-C, associating with advanced stage of HIV-1 infection. Lipid changed remarkably in the initial stage after ART therapy.