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Lipid levels increased for patients on suppressive ART regimen
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GLASGOW — HIV-positive patients on a suppressive ART regimen have high levels of total cholesterol, HDL cholesterol and triglycerides, according to new findings from the Data Collection on Adverse Events of Anti-HIV Drugs, or D:A:D, study.
David A. Kamara, MSc, of University College London, and colleagues investigated the effect of ART, HIV viremia and immunosuppression on levels of total cholesterol, HDL cholesterol and triglycerides among participants in the D:A:D study. Upon or after enrollment, 91% of the nearly 50,000 participants contributed a total cholesterol measurement, 89% a triglyceride measurement and 78% a HDL measurement.
According to data Kamara presented here at the HIV11 Congress, patients off ART had lower lipid levels when compared with patients who were on ART and had a suppressed viral load. Non-suppressive ART was also associated with lower levels of total and HDL cholesterol, but had no effect on triglycerides, according to the study abstract. For this study, ART and viral load status were combined (no ART and vital load >100,000; no ART and viral load <100,000; ART and vital load >500; or ART and vital load <500).
A low current CD4 count was also associated with lower lipid levels, whereas a low nadir CD4 count was associated with higher total cholesterol and triglyceride levels. Current and nadir CD4 counts were categorized as <200, 200 to 349, 350 to 499, and >500 cells/mm3.
In addition, patients with prior AIDS diagnosis had higher total cholesterol and triglyceride levels, but lower HDL cholesterol levels.
“The higher total cholesterol and triglyceride [levels] and lower HDL cholesterol levels seen among those with low nadir CD4 count and with a prior AIDS diagnosis suggests severe immunosuppression may be associated with dyslipidemia over the long term,” the researchers wrote in the study abstract.
Three-quarters of participants in the study were men, three-quarters did not have AIDS and half were white. Treatment history was as follows: 61% had experience with ART; 47% were previously exposed to protease inhibitors; 61% were previously exposed to nucleotide reverse transcriptase inhibitors; 29% were previously exposed to non-nucleoside reverse transcriptase inhibitors; and 4% were not receiving lipid-lowering drugs.
Of note, specific drug classes were not considered for the D:A:D study.
“In this study, we saw that lipid levels are considerably higher for those on a suppressive ART regimen,” Kamara said during his presentation. “Future longitudinal analyses will consider the impact of specific ARTs and duration of ART on lipid levels.”
For more information:
Kamara D. #P34. Presented at: HIV11 Congress; Nov. 11-15, 2012; Glasgow.
Disclosure: Kamara reports no relevant financial disclosures.