Introduction: There is no doubt that highly active antiretroviral therapy (ART) has decreased the total mortality of HIV-infected populations drastically, and HIV has become a chronic and manageable condition. However, complications after long-term treatment of ART tarnished the great efforts. We aimed to study the effects of add-on lipid-lowering agents on ART for patients who developed hyperlipidemia after HIV treatment. The risk factors for failure to normalize lipid profile were analyzed.
Materials and methods: HIV-infected patients who visited outpatient clinics of Taoyuan General Hospital between July 2013 and January 2014 were retrospectively reviewed. Subjects who needed the management of dyslipidemia were enrolled. Total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) were regularly followed up for at least 6 months. ART modification and add-on lipid-lowering agents for dyslipidemia were analyzed.
Results: There were 926 HIV-infected patients undertaking ART in the hospital during the study period. Among them, 23.2% of patients undergoing lopinavir-based regimen, 8.4% efavirenz-based regimen, 4.2% darunavir-based regimen, 3.3% nevirapine-based regimen, 2.4% raltegravir-based regimen and 2.3% atazanavir-based regimen developed dyslipidemia. There were 76 patients (8.2%) who needed management of dyslipidemia (Table 1). Among them, 97% received lipid-lowering agents, and 17% switched to lipid-friendly ART (atazanavir, boosted atazanavir, boosted darunavir, nevirapine or raltegravir) despite statins or fibrates used. Mean values (mg/dL) of TC/ TG/LDL were, respectively, 279/422/139 before enrolment, 209/270/114 at 4-12 weeks and 206/250/121 at 48 weeks (p<0.05 for baseline compared to 4-12 weeks and 1 year, respectively). No obvious changes in HDL were noted. In Cox proportional hazard model, patients who received lopinavir (adjusted hazard ratio [aHR], 0.293; 95% confidence interval [CI], 0.110-0.784; p=0.015) or efavirenz (aHR, 0.185; 95% CI, 0.072-0.447; p=0.005) were less likely to achieve normalization of TC (<200 mg/dL) and TG (<200 mg/dL). Modification of ART (aHR, 1.807; 95% CI, 0.828-3.944; p=0.137) did not change the outcome (Figure 1).
Conclusions: Efavirenz and lopinavir were independent factors for the persistence of dyslipidemia despite adding lipid-lowering agents. ART associated with a favourable lipid profile would be considered in the modern era, and this certainly leaves the question of cost versus benefit.