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Longitudinal analysis of the associations between antiretroviral therapy, viraemia and immunosuppression with lipid levels: the D:A:D study.

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Kamara David A, Smith Colette, Ryom Lene, Reiss Peter, Rickenbach Martin, Phillips Andrew, Mocroft Amanda, De Wit Stephan, Law Matthew, Monforte Antonella d'Arminio, Dabis Francois, Pradier Christian, Lundgren Jens D, Sabin Caroline,
Project Swiss HIV Cohort Study (SHCS)
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Original article (peer-reviewed)

Journal Antiviral therapy
Page(s) 495 - 506
Title of proceedings Antiviral therapy
DOI 10.3851/imp3051

Open Access

URL https://www.intmedpress.com/journals/avt/article.cfm?id=3051&pid=48&sType=AVT
Type of Open Access Repository (Green Open Access)

Abstract

Antiretroviral (ART) drugs have been associated with higher triglycerides (TG), higher total cholesterol (TC) and lower high-density lipoprotein cholesterol (HDL-C) levels. Associations between lipid levels with HIV viraemia and immunosuppression in the presence of ART remain unclear. Participants from the D:A:D study with at least one TG/TC/HDL-C measurement were included. Linear mixed effect models were used to determine the association of ART, viral load (VL), nadir and current CD4(+) T-cell count and previous AIDS diagnosis with lipids. Of 49,717 participants, 90%, 92% and 80% contributed at least one TG/TC/HDL-C measurement (median follow-up 6.8, 6.8 and 5.0 years, respectively). Predicted mean (95% CI) baseline levels for TG, TC and HDL-C (mmol/l), were 2.10 (2.05, 2.14), 4.94 (4.91, 4.98) and 1.08 (1.07, 1.10), respectively. Lopinavir was associated with the worst TG profile, (27.2% higher levels compared to atazanavir; 95% CI 25.2%, 29.2%), and darunavir had a similar profile as atazanavir. The nucleoside pair lamivudine/tenofovir was associated with the most favourable TG profile (-2.8%; -3.5%, -2.0%) compared with emtricitabine/tenofovir, whereas lamivudine/abacavir (+10.2%; +9.3%, +11.2%) and lamivudine/stavudine (+8.0%; +6.9%, +9.0%), were associated with the worst. Raltegravir was associated with lower TG (-5.2%; -6.4%, -3.9%), and nevirapine had a more favourable HDL-C profile (+11.3%; +10.8%, +11.7%) than efavirenz (+5.3%; 5.0%, 5.7%), compared to atazanavir. Higher VLs were associated with lower TG/TC/HDL-C, whereas higher CD4(+) T-cell counts were associated with higher TG/TC/HDL-C. TG, TC and HDL-C levels, which generally improved over time, are dependent on ART, viraemia and, to a lesser extent, immunosuppression.
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