Vnitr Lek 2011, 57(5):463-471

Blood lipid changes at long-term antiretroviral treatment

S. Snopková^1,*, J. Jarkovský², M. Matýšková³, K. Povolná¹, P. Polák¹, M. Cvanová², P. Husa¹

¹ Klinika infekčních chorob Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Petr Husa, CSc.

² Institut biostatistiky a analýz Lékařské a Přírodovědecké fakulty MU Brno, ředitel doc. RNDr. Ladislav Dušek, Ph.D.

³ Oddělení klinické hematologie FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Miroslav Penka, CSc.

The aim of study was to find the development trend of blood lipid concentration in a group of HIV positive patients treated by combination antiretroviral therapy (cART). We followed changes during the therapy and evaluated their aterogennic nature.

Methods:
The group included 118 patients stepwise allocated to the AIDS Centre of the Faculty Hospital Brno, with the monitoring period being up to 1 month as the minimum and up to 17 years as the maximum. The patients were divided into cART treated patients and not treated patients. The following parameters were analysed: total cholesterol, triglycerides, HDL-cholesterol, apolipoprotein B, the total cholesterol/HDL-cholesterol index and non-HDL-cholesterol.

Results:
Our group experienced a statistically significant increase of total cholesterol concentration already in the first months after cART initiation and this value continuously increased in the following years. The recommended target value for total cholesterol (5 mmol/ l) was exceeded in the group of patients after 3 - 4 years of cART initiation. The triglyceride concentration showed a sudden increase already a few months after cART initiation, when the recommended optimum value of triglycerides (1.7 mmol/ l) was exceeded. These changes had a further no statistic significance. The average triglyceride value was all around (slightly above) 1.7 mmol/ l. Our group experienced a statistically significant increase of HDL-cholesterol concentration in the first two years after cART initiation. A statistically significant change of HDL-cholesterol concentration was not found in the following years. The average HDL-cholesterol value was above optimal value HDL-Ch > 1.0 mmol/ l for men (except initial category). A statistically significant change of apolipoprotein B concentration was found after 3 - 4 years of cART treatment. However, the average apolipoprotein B value did not exceed the target value in any of the followed categories. No statistically significant changes of the total cholesterol/HDL-cholesterol index were found. The resulting value was under 5 in all the followed categories. Statistically significant changes of non-HDL-cholesterol were found in patients with cART already a few months after treatment initiation and its concentration continually increased. However, the recommended target value of non-HDL-cholesterol (3.8 mmol/ l) was exceeded only in the category of patients treated 4 - 5 years. The development trend of CD4⁺ lymphocyte count and HIV-1 RNA copies means high active of cART from standpoind of immunoregeneration (CD4⁺ lymphocyte count) and viral suppression (HIV-1 RNA copies) even in the group of treated patient with the longest monitoring period.

Conclusion:
Monitoring of our group of HIV-positive patients treated by combination antiretroviral therapy revealed a statistically significant increase of blood lipid concentrations (inclusive of HDL-cholesterol) during the treatment. However, these changes do not have an unequivocally aterogennic nature even in the group of treated patient with the longest monitoring period.

Keywords: HIV; combined antiretroviral therapy; total cholesterol; triglycerides; apolipoprotein B; index total cholesterol, HDL-cholesterol; non-HDL-cholesterol; CD4⁺ lymphocytes; HIV-1 RNA

Received: March 31, 2010; Accepted: January 10, 2011; Published: May 1, 2011  Show citation