Abstract
HIV-infected patients exposed to antiretroviral therapy (ART) have an increased risk for hyperlipidemia and cardiovascular disease. We performed a longitudinal, comprehensive, and population-based study to investigate the cumulative effect of different types of ART regimens on hyperlipidemia risk in the Taiwanese HIV/ART cohort. A total of 13,370 HIV-infected patients (2,674 hyperlipidemia and 10,696 non-hyperlipidemia patients) were recruited after matching for age, gender, and the first diagnosis date of HIV infection by using the National Health Insurance Research Database in Taiwan. Hyperlipidemia risk associated with cumulative ART use, ART adherence, and their combination was assessed. The matched hyperlipidemia group had a larger number of patients using ART and a higher incidence of comorbidities, specifically, respiratory disease and diabetes. Patients with high ART dosage and dose-dependent manner adherence, respectively, demonstrated an increased risk of hyperlipidemia. For single ART regimens, patients receiving nucleoside reverse-transcriptase inhibitors (NRTI/NRTI)- containing regimen had the highest hyperlipidemia risk, followed by protease inhibitor (PI)- containing and non-NRTI- containing regimens. For combination ART regimens, patients receiving a NRTI/NRTI + PI regimen had the highest hyperlipidemia risk. An increased cumulative drug dose was observed in patients who received the PI, NRTI/NRTI, NRTI, and NNRTI regimens in the hyperlipidemia group, when compared to the non-hyperlipidemia group. In conclusion, ART cumulative use, adherence, and regimen may affect hyperlipidemia risk among HIV-infected patients in a dose-dependent manner.
Highlights
According to reports from the WHO (World Health Organization) and the UNAIDS (The Joint United Nations Programme on human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS)), the estimated number of people living with HIV/ AIDS (PLWHA) in 2015 was 36.9 million [1]
The hyperlipidemia cases were characterized by older age, longer follow-up years, an increased incidence in males subjects, for antiretroviral therapy (ART) use, and comorbidities, respectively (p < 0.001)
The incidence-density sampling match method was used to match the hyperlipidemia and non-hyperlipidemia groups. After matching these two groups for age, gender, and the first diagnosis date of HIV infection, 2,674 hyperlipidemia and 10,696 non-hyperlipidemia patients were included in this analysis (Figure 1 and Table 1 right side)
Summary
According to reports from the WHO (World Health Organization) and the UNAIDS (The Joint United Nations Programme on HIV/AIDS), the estimated number of people living with HIV/ AIDS (PLWHA) in 2015 was 36.9 million [1]. 17 million people receive antiretroviral therapy (ART). With the aid of ART regimens, HIV replication has been effectively suppressed, and subsequent AIDS-related mortality and morbidity have reduced in these patients [2]. The use of ART has led to decreased risks of drug resistance, HIV transmission and AIDS disease progression as well as improved overall health, quality of life, and survival [3, 4]. Adverse effects have been reported for all antiretroviral (ARV) drugs; this is one of the most common reasons for discontinuing or switching ART [5, 6]. Since ART is recommended for all patients, regardless of CD4 T lymphocyte (CD4) cell count, awareness regarding the adverse effects of its long-term use is paramount. Some of the long-term effects include bone or renal toxicity, hyperlipidemia, diabetes mellitus, or accelerated cardiovascular disease [7,8,9,10,11]
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