Antiretroviral therapy and its impact on lipid metabolic parameters

Abstract

The aim of the investigation was to study the frequency and magnitude of changes in lipid metabolic parameters in the use of various antiretroviral therapy (ARVT) regimens for 72 weeks in HIV-infected patients initiating the therapy for the first time. Lipid metabolic parameters were analyzed in 146 adult HIV-infected patients. Lipid metabolic disturbances were estimated from the variations in body build and the change in the levels of total cholesterol (TC), triglycerides (TG), high-density lipoproteins (HDL), low-density lipoproteins (LDL), and atherogenicity index (AI), which had been measured before and 24, 48, and 72 weeks after therapy.All the test antiretroviral drugs affect lipid profile just during early treatment. The most common metabolic disturbance was elevated triglycerides when ritonavir-boosted protease inhibitors, lopinavir in particular, were administered. However, in this drug group, AI was minimal (1.29) due to the significantly higher concentration of HDL. Non-nucleotide reverse HIV transcriptase generally failed to affect the level of TC, TG, and LDL, but reduced HDL concentrations, which resulted in a pronounced increase in AI (4.4) following 72 weeks of treatment. The unboosted protease inhibitors atazanavir and nelfinavir were the safest agents in terms of metabolic disturbances. None of the patients developed lipodystrophy 72 weeks after therapy.Thus, it is expedient to determine lipid metabolic parameters and body build before start of therapy and at least every 6 months in all HIV-infected patients in order to prevent lipodystrophy and/or cardiovascular diseases.

Keywords

HIV infection / antiretroviral therapy / dyslipidemia / lipodystrophy

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