Improvement in lipid profiles over 6 years of follow-up in adults with AIDS and immune reconstitution

Paige L. Williams, J. W. Wu, S. E. Cohn, S. L. Koletar, J. A. McCutchan, R. L. Murphy, J. S. Currier, Bev Putnam, Graham Ray, Harold Kessler, Oluwatoyin Adeyemi, Susan Cahill, Julie Hoffman, Robert Salata, Patricia Galloway, Mary M. Payne, Jody Lawrence, Jane Reid, Tammy O'Hara, Jane NorrisSandra Valle, Kathleen E. Squires, Kathy Watson, Charlotte Mills, Charlene Gaca, Timothy Cooley, Mallory Witt, Sadia Shaik, Janet Forcht, Charles Gonzales, Marshall Glesby, Valery Hughes, Sheryl Storey, Jeff Schouten, Henry H. Balfour, Christine Fietzer, Clifford Gunthel, Ericka Patrick, William A. O'Brien, Gerianne Casey, Mark Rodriguez, Lisa Kessels, Judith Feinberg, Tammy Powell, Mitchell Goldman, Beth Zwickl, Joan Riddle, Pualette MacDougall, Charles van der Horst, David Ragan, Ellen Chusid, Walter Weiss, Donna Mildvan, John McNeil, Rob Roy MacGregor, Kathryn Maffei, Ilene Wiggins, Robin Worrell-Thorne, Rebecca A. Clark, James Paul Steinberg

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Objectives: The aim of the study was to evaluate long-term changes in lipids and to assess other coronary heart disease (CHD) risk factors in highly experienced AIDS patients with immune reconstitution, and to examine their association with antiretroviral therapy (ART). Methods: We evaluated 433 AIDS patients with prior severe immunosuppression and ART-based immune reconstitution, followed in a multicentre prospective observational study between 2000 and 2006. We estimated the prevalence at entry of hypercholesterolaemia and metabolic syndrome, and 10-year CHD risks. Trends in total cholesterol (TC), triglycerides (TG) and high-density lipoprotein (HDL) cholesterol were evaluated over time, and use of specific ART drugs at each study visit was assessed using mixed effect models, adjusting for CHD risk factors and use of lipid-lowering agents. Results: At entry to observational follow-up, 28% of the 433 subjects had hypercholesterolaemia and 15% had a predicted 10-year CHD risk above 20%. Average TC and fasting TG levels declined over the follow-up period (median = 5.8 years), and these declines were associated with increased use of physician-prescribed lipid-lowering agents and changes in ART regimens. After adjustment for CHD risk factors, TC and TG levels were significantly higher for those on ritonavir-boosted protease inhibitors and those on nonnucleoside reverse transcriptase inhibitors (NNRTIs), particularly efavirenz, than for other patients. Conclusions: Abnormalities in serum lipids were common at baseline but became less so over time, and this improvement was associated with increased use of lipid-lowering agents and selection of ART agents with less deleterious effects on lipids.

Original languageEnglish (US)
Pages (from-to)290-301
Number of pages12
JournalHIV Medicine
Volume10
Issue number5
DOIs
StatePublished - May 8 2009

Keywords

  • Cardiovascular disease
  • Cholesterol
  • HAART
  • Immune reconstitution
  • Metabolic syndrome

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    Williams, P. L., Wu, J. W., Cohn, S. E., Koletar, S. L., McCutchan, J. A., Murphy, R. L., Currier, J. S., Putnam, B., Ray, G., Kessler, H., Adeyemi, O., Cahill, S., Hoffman, J., Salata, R., Galloway, P., Payne, M. M., Lawrence, J., Reid, J., O'Hara, T., ... Steinberg, J. P. (2009). Improvement in lipid profiles over 6 years of follow-up in adults with AIDS and immune reconstitution. HIV Medicine, 10(5), 290-301. https://doi.org/10.1111/j.1468-1293.2008.00685.x