Dyslipidemia and Fasting Glucose Impairment among HIV-InfectedPatients 48-Weeks after the First Antiretroviral Regimen

Background: People infected with human immunodeficiency virus (HIV) develop lipid and glucose metabolic alterations, which predisposes them to cardiovascular disease. The aim of this study was to evaluate the cumulative incidence of dyslipidemia and fasting glucose impairment after 48 weeks of initiating the first antiretroviral (ART) regimen and the association with the type of ART regimen. Method: Retrospective cohort of HIV-1 infected patients attending in the AIDS clinic of five centers of the country, between February 2009 and March 2013. Lipids (total cholesterol and triglycerides) and fasting glucose, were collected prior and 48 weeks after starting ART. We assessed risk factors for dyslipidemia and fasting glucose. To adjust for the effects of potential confounders of metabolic alterations we used logistic regression model. Results: During the study, 223 patients on ART were evaluated. Median age was 34 years [interquartile range (IQR): 28-43]. Of the total patients, 201 (90%) were men. Most common OBR regimens were tenofovir/emtricitabine (TDF/FTC), and efavirenz (EFV) in 42%, abacavir/lamivudine (ABC/3TC) +EFV in 16.6% and TDF/FTC+nevirapine (NVP) in 11.7% patients. Cumulative incidence per 1,000 patients/year of glucose ≥ 100 mg/dL was 233.1, total cholesterol >200 mg/dL was 273.5 and tryglicerides >200 mg/dL was 372.2. The proportion of patients with hypertriglyceridemia (>200 mg/dL) at 48 weeks of ART initiation was 37.2% (95% CI: 31.1-43.7%), hypercholesterolemia (>200 mg/dL) 32.3% (95% CI: 26.5-38.6%) and impairment of fasting glucose (IFG) (>100 mg/dL) 23.3% (95% CI: 18.2-29.2%), After adjustment in a logistic regression model for IFG, EFV-containing regimen OR 2.9 (95%CI 1.12-7.45); p=0.027; for hypertriglyceridemia, age >40 years old OR=1.9 (95% CI: 1.01-3.63); p=0.044, ABC/LAM-containing regimen OR=2.69 (95% CI: 1.42-5.09); p=0.002 and LPV/r-containing regimen OR=5.04 (95% CI 2.32-10.92); p=0.001 were significant; finally, for hypercholesterolemia age >40 years old OR=2.4 (95% CI: 1.15- 4.9); p=0.004 and ABC/3TC-containing regimen OR=1.87 (95% CI: 1.01-3.49); p=0.05 remain significant. Conclusion: These data show high risk of cumulative incidence of IFG and dyslipidemia after initiation of ART. Age >40 years old, ABC/3TC and LPV/r-containing regimens were independent factors to develop dyslipidemia and EFV-containing regimen for IFG in this cohort.