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Impact of second-line antiretroviral regimens on lipid profiles in an African setting: the DART trial sub-study
BACKGROUND: Increasing numbers of HIV-infected patients in sub-Saharan Africa are exposed to antiretroviral therapy (ART), but there are few data on lipid changes on first-line ART, and even fewer on second-line. METHODS: DART was a randomized trial comparing monitoring strategies in Ugandan/Zimbabw...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4197260/ https://www.ncbi.nlm.nih.gov/pubmed/25320632 http://dx.doi.org/10.1186/1742-6405-11-32 |
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author | Gomo, Zvenyika AR Hakim, James G Walker, Sarah A Tinago, Willard Mandozana, Gibson Kityo, Cissy Munderi, Paula Katabira, Elly Reid, Andrew Gibb, Diana M Gilks, Charles F |
author_facet | Gomo, Zvenyika AR Hakim, James G Walker, Sarah A Tinago, Willard Mandozana, Gibson Kityo, Cissy Munderi, Paula Katabira, Elly Reid, Andrew Gibb, Diana M Gilks, Charles F |
author_sort | Gomo, Zvenyika AR |
collection | PubMed |
description | BACKGROUND: Increasing numbers of HIV-infected patients in sub-Saharan Africa are exposed to antiretroviral therapy (ART), but there are few data on lipid changes on first-line ART, and even fewer on second-line. METHODS: DART was a randomized trial comparing monitoring strategies in Ugandan/Zimbabwean adults initiating first-line ART and switching to second-line at clinical/immunological failure. We evaluated fasting lipid profiles at second-line initiation and ≥48 weeks subsequently in stored samples from Zimbabwean patients switching before 18 September 2006. RESULTS: Of 91 patients switched to second-line ART, 65(73%) had fasting samples at switch and ≥48 weeks, 14(15%) died or were lost <48 weeks, 10(11%) interrupted ART for >14 days and 2(2%) had no samples available. 56/65(86%) received ZDV/d4T + 3TC + TDF first-line, 6(9%) ZDV/d4T + 3TC + NVP and 3(5%) ZDV + 3TC with TDF and NVP. Initial second-line regimens were LPV/r + NNRTI in 27(41%), LPV/r + NNRTI + ddI in 33(50%) and LPV/r + TDF + ddI/3TC/ZDV in 6(9%). At second-line initiation median (IQR) TC, LDL-C, HDL-C and TG (mmol/L) were 3.3(2.8-4.0), 1.7(1.3-2.2), 0.7(0.6-0.9) and 1.1(0.8-1.9) respectively. Levels were significantly increased 48 weeks later, by mean (SE) +2.0(0.1), +1.1(0.1), +0.5(0.05) and +0.4(0.2) respectively (p < 0.001; TG p = 0.01). 3% at switch vs 25% 48 weeks later had TC >5.2 mmol/L; 3% vs 25% LDL-C >3.4 mmol/L and 91% vs 41% HDL-C <1.1 mmol/L (p < 0.001). Similar proportions had TG >1.8 mmol/L (0 vs 3%) and TC/HDL-C ≥5 (40% vs 33%) (p > 0.15). CONCLUSION: Modest lipid elevations were observed in African patients on predominantly LPV/r + NNRTI-based second-line regimens. Routine lipid monitoring during second-line ART regimens may not be warranted in this setting but individual cardiovascular risk assessment should guide practice. |
format | Online Article Text |
id | pubmed-4197260 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-41972602014-10-16 Impact of second-line antiretroviral regimens on lipid profiles in an African setting: the DART trial sub-study Gomo, Zvenyika AR Hakim, James G Walker, Sarah A Tinago, Willard Mandozana, Gibson Kityo, Cissy Munderi, Paula Katabira, Elly Reid, Andrew Gibb, Diana M Gilks, Charles F AIDS Res Ther Research BACKGROUND: Increasing numbers of HIV-infected patients in sub-Saharan Africa are exposed to antiretroviral therapy (ART), but there are few data on lipid changes on first-line ART, and even fewer on second-line. METHODS: DART was a randomized trial comparing monitoring strategies in Ugandan/Zimbabwean adults initiating first-line ART and switching to second-line at clinical/immunological failure. We evaluated fasting lipid profiles at second-line initiation and ≥48 weeks subsequently in stored samples from Zimbabwean patients switching before 18 September 2006. RESULTS: Of 91 patients switched to second-line ART, 65(73%) had fasting samples at switch and ≥48 weeks, 14(15%) died or were lost <48 weeks, 10(11%) interrupted ART for >14 days and 2(2%) had no samples available. 56/65(86%) received ZDV/d4T + 3TC + TDF first-line, 6(9%) ZDV/d4T + 3TC + NVP and 3(5%) ZDV + 3TC with TDF and NVP. Initial second-line regimens were LPV/r + NNRTI in 27(41%), LPV/r + NNRTI + ddI in 33(50%) and LPV/r + TDF + ddI/3TC/ZDV in 6(9%). At second-line initiation median (IQR) TC, LDL-C, HDL-C and TG (mmol/L) were 3.3(2.8-4.0), 1.7(1.3-2.2), 0.7(0.6-0.9) and 1.1(0.8-1.9) respectively. Levels were significantly increased 48 weeks later, by mean (SE) +2.0(0.1), +1.1(0.1), +0.5(0.05) and +0.4(0.2) respectively (p < 0.001; TG p = 0.01). 3% at switch vs 25% 48 weeks later had TC >5.2 mmol/L; 3% vs 25% LDL-C >3.4 mmol/L and 91% vs 41% HDL-C <1.1 mmol/L (p < 0.001). Similar proportions had TG >1.8 mmol/L (0 vs 3%) and TC/HDL-C ≥5 (40% vs 33%) (p > 0.15). CONCLUSION: Modest lipid elevations were observed in African patients on predominantly LPV/r + NNRTI-based second-line regimens. Routine lipid monitoring during second-line ART regimens may not be warranted in this setting but individual cardiovascular risk assessment should guide practice. BioMed Central 2014-10-02 /pmc/articles/PMC4197260/ /pubmed/25320632 http://dx.doi.org/10.1186/1742-6405-11-32 Text en © Gomo et al.; licensee BioMed Central Ltd. 2014 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Gomo, Zvenyika AR Hakim, James G Walker, Sarah A Tinago, Willard Mandozana, Gibson Kityo, Cissy Munderi, Paula Katabira, Elly Reid, Andrew Gibb, Diana M Gilks, Charles F Impact of second-line antiretroviral regimens on lipid profiles in an African setting: the DART trial sub-study |
title | Impact of second-line antiretroviral regimens on lipid profiles in an African setting: the DART trial sub-study |
title_full | Impact of second-line antiretroviral regimens on lipid profiles in an African setting: the DART trial sub-study |
title_fullStr | Impact of second-line antiretroviral regimens on lipid profiles in an African setting: the DART trial sub-study |
title_full_unstemmed | Impact of second-line antiretroviral regimens on lipid profiles in an African setting: the DART trial sub-study |
title_short | Impact of second-line antiretroviral regimens on lipid profiles in an African setting: the DART trial sub-study |
title_sort | impact of second-line antiretroviral regimens on lipid profiles in an african setting: the dart trial sub-study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4197260/ https://www.ncbi.nlm.nih.gov/pubmed/25320632 http://dx.doi.org/10.1186/1742-6405-11-32 |
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