Changes in Lipid Profile Over 24 Months Among Adults on First-Line Highly Active Antiretroviral Therapy in the Home-Based AIDS Care Program in Rural Uganda

• DOI: 10.1097/qai.0b013e31815e7453
• Publication Date: 2009-03-05T15:00:19Z
• Authors: Kate Buchacz; Paul J Weidle; David Moore; Willy Were; Jonathan Mermin; Robert Downing; Aminah Kigozi; Craig B Borkowf; Vincent Ndazima; John T Brooks
• Keywords: Nevirapine; Efavirenz; Stavudine; Dyslipidemia; Abacavir

Background: Use of highly active antiretroviral therapy (HAART) has been linked to dyslipidemia and increased risk cardiovascular disease (CVD) in HIV-infected patients industrialized countries. The effects HAART on lipid metabolism among sub-Saharan Africans, for whom access is expanding, remain largely unknown. Methods: From July 2003 May 2004, 987 antiretroviral-naive with symptomatic HIV or a CD4 count <250 cells/mm3 were started the Home-Based AIDS Care (HBAC) Program Tororo, Uganda. HBAC provided weekly drug delivery field-based clinical monitoring. Nonfasting repository sera from subset 374 analyzed levels total cholesterol (TC), direct low-density lipoprotein (LDL-c), high-density (HDL-c), triglycerides (TG) at baseline (before HAART) after 12 24 months using Randox enzymatic kits (Crumlin, United Kingdom). Results: evaluated (49% women, mean age = 39 years, 124 cells/mm3, body mass index 19.7 kg/m2) received initial composed stavudine, lamivudine, either nevirapine (365 [98%]) efavirenz (9 [2%]). During months, 99 (26%) had single substitutions stavudine zidovudine 27 (7%) efavirenz. At baseline, serum concentrations 120 mg/dL TC, 53 LDL-c, 29 HDL-c, 123 TG; values generally comparable men women. treatment, TC by 31 mg/dL, LDL-c 26 HDL-c 19 whereas TC/HDL-c ratio decreased 4.6 3.4 (all changes, P < 0.001). TG initially then returned months. respectively, was ≥200 2% 10% patients, ≥130 1% 6%, <40 88% 41%, ≥150 23% 20%. Conclusions: Rural Ugandans advanced initiating nevirapine- efavirenz-based experienced infrequent elevations therapy. Increases substantial proportionally greater than increases levels. CVD how it affected changes this rural African population are However, we observed seem unlikely increase CVD.