Alteration in Lipid Profile in Treatment-Naive HIV-Infected Patients and Changes Following HAART Initiation in Haryana

Abstract

Background: Abnormalities of lipid metabolism are common in human immunodeficiency virus (HIV)-infected patients and tend to be accentuated in those receiving highly active antiretroviral therapy (HAART). However, data on lipid profile of treatment- naive HIV-infected patients in India are limited. So, the study was conducted to describe the pattern of lipid profile among treatment- naive HIV-positive patients and changes following HAART initia- tion in Haryana. Methods: Data were collected from 100 normotensive, non-diabet- ic and non-obese, treatment-naive HIV-infected patients (65 men and 35 women, mean age 36.4 years) and 100 healthy controls. The study was carried out at ART center in PGIMS, Rohtak for a period of 1 year. Fasting lipid profiles were analyzed enzymatically. Values of lipid parameter were retrieved after 3 and 6 months on HAART. Results: The study observed a significant increased level of tri- glyceride (TG) (178.46 ± 58.41 mg%) and low density lipopro- tein cholesterol (LDL-C) (108.62 ± 38.67 mg%) and a significant decreased level of high density lipoprotein cholesterol (HDL-C) (26.86 ± 12.69 mg%) as compared to HIV-negative healthy con- trols. Total cholesterol (TC) was also low (171.17 ± 52.24 mg%) as compared to controls though this is not significant statistically. Fol- lowing HAART initiation, there were large increases in mean TC, TG and LDL-C values at 3 months and further increase at 6 monthsof therapy (12.01, 17.26 and 16.71 mg% respectively) with statisti- cally highly significant P value (< 0.001). HDL levels remained low throughout follow-up. A total of 61% patients showed dyslipidemia following HAART. Conclusions: HIV-1 replication alone without any influence of antiviral drugs or other human genetic factors induces changes in serum lipid profile parameters which could be used to determine HIV-infected persons with high risk of myocardial infarction be- fore enrollment for HAART. Therefore, fasting plasma lipid profile should be done of all HIV-infected persons before starting HAART with periodic repetitions after enrolling on HAART, since signifi- cant increases in plasma TG, TC and LDL-C concentrations have been reported in HIV patients on HAART. Lipid profile results can therefore be a good index for disease progression, intervention and management of HIV patients. Keywords: Highly active antiretroviral therapy; Human immuno- deficiency virus; Low density lipoprotein; Very low density lipo- protein; High density lipoprotein; Triglyceride; Total cholesterol Introduction