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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 12  |  Issue : 2  |  Page : 111-115

Therapy-related lipid profile changes among patients' on highly active antiretroviral treatment in Kano, North-Western Nigeria


Department of Chemical Pathology, Bayero University, Kano, Nigeria

Date of Web Publication10-Nov-2015

Correspondence Address:
Idris Y Mohammed
Department of Chemical Pathology, Bayero University, Kano, Nigeria
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0331-8540.169289

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  Abstract 

Context: Highly active antiretroviral therapy (HAART), an effective treatment for human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) results in significant reduction in viral load, increased CD4 cell count and improved quality of life of people living with HIV/AIDS. HAART being a life-long treatment increases the propensity for manifesting long-term complications like changes in lipid profile. Aims: This study set out to assess therapy induced lipid profile changes among patients on HAART in Kano North-Western Nigeria. Design: Cross-sectional. Settings: This study was conducted at the HIV clinic of the Aminu Kano Teaching Hospital, Nigeria. Subjects and Methods: The study group consist of 120 patients on HAART (Group I) and 120 HAART naïve patients (Group II). Results: The mean values of cholesterol, triglyceride (TG), low-density lipoprotein cholesterol (LDLC) and high-density lipoprotein cholesterol (HDLC) were 4.15 mmol/L ± 1.03, 1.79 mmol/L ± 0.67, 2.79 mmol/L ± 0.98 and 0.99 mmol/L ± 0.28 in Group I, respectively and were statistically significantly higher than 3.50 mmol/L ± 0.94, 1.21 mmol/L ± 0.55, 1.13 mmol/L ± 0.45 and 0.91 mmol/L ± 0.30 in Group II (P < 0.05). The prevalence of dyslipidaemia was high total cholesterol in Group I (25%) Group II (7.5%): high TG in Group I (30%) > Group II (7.5%): High LDLC in Group I (30%) > Group II (17.5%) low HDLC in Group II (40%) >xb Group I (35%). The prevalence of hypertriglyceridemia was 43% in the protease inhibitor (PI) based and 16.7% in 'the non-PI based groups respectively. Conclusions: This study confirms the existence of artherogenic lipid profile in patients on HAART (especially those on PI-based regimen) and further underscores the importance of close monitoring to prevent cardiovascular complications.

Keywords: Dyslipidaemia, highly active antiretroviral therapy, human immunodeficiency virus/acquired immune deficiency syndrome


How to cite this article:
Mohammed IY, Yahaya IA. Therapy-related lipid profile changes among patients' on highly active antiretroviral treatment in Kano, North-Western Nigeria. Niger J Basic Clin Sci 2015;12:111-5

How to cite this URL:
Mohammed IY, Yahaya IA. Therapy-related lipid profile changes among patients' on highly active antiretroviral treatment in Kano, North-Western Nigeria. Niger J Basic Clin Sci [serial online] 2015 [cited 2021 Jun 23];12:111-5. Available from: https://www.njbcs.net/text.asp?2015/12/2/111/169289


  Introduction Top


The human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) pandemic continues to spread around the world at an alarming rate, and the number of people with the disease keep growing significantly, as it becomes more geographically diffuse. There are 33.3 million people globally living with HIV, out of which 22.5 million are living in Sub-Saharan Africa.[1] HIV/AIDS is a global crisis, a challenge to human life and dignity with the ability to erode social and economic development. It has great influence on stability, life expectancy and economic development.

In Nigeria, estimates by the Federal Ministry of Health Indicated that 2.98 million people were living with HIV/AIDS in 2009 with a total AIDS death of 192, 000.[2] The current prevalence rate is 4.1% with an estimated 3,458,363 people living with the virus and annual deaths of 217,121.[3]

Advances in the treatment of this infection with the advent of highly active antiretroviral therapy (HAART) resulted in significant reduction in HIV/AIDS morbidity and mortality. These highly effective therapies come with several side effects that are likely to increase as patients live longer. Changes in serum lipids tending towards artherogenic profile is one of such metabolic complications that may arise with the use of HAART. Therapy-induced dyslipidaemias seen is characterised by increased low-density lipoproteins (LDL) and very LDL (VLDL). The constellation of dysmorphic features described as lipodystrophy syndrome presents with redistribution of body fat, peripheral lipoatrophy and central fat accumulation. The pathogenesis of these metabolic disturbances is not well understood and probably represents a complex interaction between HIV infection itself, use of antiretroviral therapy and the immune reconstitution effects of treatment.

These metabolic abnormalities may harbour a significant risk of developing cardiovascular disease. This fear is further reinforced by many multicentre studies that documented increased risk of arterial hypertension and myocardial infarction following HAART use.[4],[5],[6]

The metabolic complications are of major importance in HIV therapy because they affect the quality of life of these patients, and can potentially reduce treatment adherence.

With this new challenge in the management of HIV/AIDS, this study was designed to evaluate dyslipidaemia in HIV/AIDS patients on HAART so as to allow for proper management of this complication as it arises.


  Subjects and Methods Top


This cross-sectional study was conducted on patients (HAART-treated and HAART naïve) attending the adult HIV clinic of the Aminu Kano Teaching Hospital (AKTH), Nigeria. The study group (Group I) consisted of 120 patients on HAART while 120 HAART naïve HIV-positive patients (Group II) were used as controls. Group I was further sub-grouped into those on the first line (Ia) and those on second line (Ib) drugs.

Systematic sampling was used to select the study subjects which included adults between the ages of 18 and 45 years. Excluded from the study were patients with evidence of pre-HAART dyslipidaemia, pregnancy, history of use of drugs that aff ect lipids such as hypolipidaemic agents and combined oral contraceptives, history of chronic disease aff ecting the kidneys, liver or heart such as hypertension, diabetes mellitus and cerebrovascular accidents, history of smoking and/or alcohol use, history suggestive of thyroid disorders, positive family history of lipid disorders, obesity, co-infections with tuberculosis and hepatitis and severe Undernutrition and wasting disease.

Patients were enrolled during a clinic visit and were required to fast overnight after which blood samples were obtained for serum lipid measurement.

Approval to carry out this study was obtained from the Ethical Research Committee of AKTH. Written informed consent was obtained from all subjects in the study, and the provision of the Helsinki declaration was respected at every step of the study.[7]

Laboratory methods

Concentrations of serum total cholesterol (TC), LDL cholesterol (LDLC), high-density lipoprotein cholesterol (HDLC) and triglycerides (TGs) were measured using enzymatic assays.

Triglycerides

TG was estimated by the enzymatic colorimetric method of glycerol phosphate oxidase.[8]

High-density lipoprotein cholesterol

Cholesterol in LDL, VLDL and chylomicron fractions was precipitated by the action of a phosphotungstic acid in the presence of magnesium ions. After centrifugation, the cholesterol concentration in the remaining HDL fraction which remains in the supernatant was determined by the enzymatic colorimetric method.[9]

Total cholesterol

This was measured by the enzymatic colorimetric method.[10]

Low-density lipoprotein cholesterol levels

This was calculated from TC, HDLC, and TG using the Friedewald formula (for samples with TG < 5 mmol/L).[11]

Outcome measure

The National Cholesterol Education Program (NCEP)/Adult Treatment Panel (ATP III) criteria were used.[12]

Quality control

Levels 1, 2 and 3 control samples were analysed with each assay run and the batch samples whose controls values fell outside the established laboratory values (> ±2 standard deviation [SD]) were repeated.

Statistical analysis of results

All data generated were collated, calculated and tabulated using Microsoft Excel spreadsheet (Microsoft. (2007). Microsoft Excel (computer software). Redmond, Washington: Microsoft). Mean values of age, body mass index and serum lipids were calculated and tabulated. Fisher's exact test was used to determine the significance of differences in the prevalence of dyslipidaemia between Groups I and II and within Group I. Analysis of variance was used to compare the lipid parameters between and within the study groups. Statistical significance was set at 95% confidence interval (P < 0.05). All data analysis were performed with a statistical package (Graph Pad, Prism 3, version 6.04 for Windows, GraphPad Software, La Jolla California, USA) and presented as a mean ± standard error of mean and normality test P value.


  Results Top


The mean age of all the participants was 35.8 ± 8.5 years while the corresponding mean age for Groups I and II were 33.46 ± 7.2 years, 34.52 ± 6.4 years respectively.

There was a slight female preponderance in all groups with 55.8% of Group I and 53.3% of Group II being females.

The mean ± SEM of lipid profiles of the controls and study group are presented in [Table 1]. The level of serum TC, TG, LDLC and HDLC were observed to be lower in the HIV-positive HAART naïve group than in patients on HAART therapy.
Table 1: Serum levels (mean±SEM) of TC, triglycerides, LDL-C, and HDL-C

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The most frequent type of dyslipidaemia observed was low HDLC, and this was most frequent in HIV-positive HAART naïve patients [Table 2]. High LDLC was more prevalent in patients that were on HAART therapy. Both hypertriglyceridaemia and hypercholesterolaemia appeared to be more common in patients on HAART.
Table 2: Prevalence of dyslipidaemia

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The prevalence of hypercholesterolaemia and hypertriglyceridaemia were higher in patients on protease inhibitor (PI) based regimen (36.7% and 43.3%) than in patients on non-PI-based regimen (13.3% and 16.7%) as shown in [Table 3].
Table 3: Prevalence of dyslipidaemia in Group I

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  Discussion Top


In this study, the mean age of the subjects with HIV infection was 33.46 ± 7.2 and 34.52 ± 6.4 years for Groups I and II, respectively. The age group with the highest number of subjects in both groups was between 30 and 34 years. This suggests that HIV infection was highest among young individuals in the area of study. Similarly, the sex distribution showed a slight female preponderance in HIV-infected study groups with 55.8% of Group I and 53.3% of Group II being females. This suggests that the disease is more common in females than males. This finding is similar to the international 2010 data from the centre for disease control which showed highest prevalence of infection in the age group between 25 and 34 years in the United States.[13] A similar age and sex pattern of HIV infection was reported in National figures of Nigeria (25–29 years).[1] A study conducted in Cameroon to determine the effect of HAART on serum lipids showed highest prevalence among 31–49 years age group with a higher proportion of women (68%) than men (32%).[14] Another study in South Africa to determine the prevalence of HIV prevalence found the highest prevalence to be among 20–24 years age group and a significantly higher prevalence (15.5%) in women than in men (4.8%).[14]

Dyslipidaemia in HIV infection has been related to elevated cholesteryl ester transfer protein activity (high HDLC) and decreased lipoprotein/hepatic TG lipase (high TGs). Studies prior to the introduction of HAART have established a decline in TC, LDLC and HDLC and a rise in TG among HIV-infected individuals.[15],[16] This decline occur more in those with lower CD4, higher viral RNA load and longer duration of treatment.[17],[18],[19],[20],[21] In this study, a statistically significant difference in the levels of serum lipids was observed between the groups. The level of serum TC, TG, LDLC and HDLC were observed to be lower in the HIV-positive HAART naïve group. This finding agrees with previous reports of a high artherogenic profile in HAART-treated patients.[22],[23]

Hypertriglyceridaemia was also found to be more prevalent (30%) in HAART-treated subjects than hypercholesterolaemia (25%). The prevalence of hypercholesterolaemia and hypertriglyceridaemia was higher in patients on PI-based regimen (36.7% and 43.3%) than in patients on non-PI-based regimen (13.3% and 16.7%) as shown in [Table 3]. This observed difference in prevalence between the groups and between Group Ia and Ib was shown to be statistically significant.x

Several studies within and outside this country have reported similar findings suggesting a higher levels and prevalence of lipid disorders in patients on HAART. Similarly, PI treatment was also observed to cause the highest prevalence in such abnormalities. Other studies linked the prolonged duration of treatment with higher risk of dyslipidaemia.[22],[23],[24],[25],[26],[27],[28],[29],[30]


  Conclusion and Recommendation Top


This study has established that dyslipidaemia is common in both HIV positive HAART naïve and HAART-treated patients. While HIV infection is associated with significant reduction in serum lipids prior to treatment, HAART is associated with higher serum levels of TC, TG, LDLC and HDLC. The prevalence of dyslipidaemia was higher in patients on PI-based HAART regimen, and they are more likely to develop dyslipidaemia than those on a PI sparing regimen.

Based on the findings in this study, the following recommendations are suggested

  • All individuals that are HIV positive should undergo a lipid profile test to detect and treat dyslipidaemia early in the disease
  • All HAART eligible patients should have a lipid profile test done with a view to establishing a baseline
  • Treatment regimen with the lowest risk of dyslipidaemia should be offered to patients commencing treatment as first-line treatment option
  • Treatment of patients with dyslipidaemia should be guided by the levels of serum lipids, Co-morbidities and risk assessment according to the NCEP/ATP III recommendations.[12]


Acknowledgement

The authors wish to thank the entire staff of Professor S. S. Wali HIV Treatment Center and Professor Christian Isichie for their support during data collection and useful comments respectively.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Report of the United Nations General Assembly Special Session. Country Progress Report: Nigeria; March, 2010.  Back to cited text no. 1
    
2.
Federal Ministry of Health Technical Report on the National HIV/Syphilis Sero-prevalence Sentinel Survey Among Pregnant Women Attending Antenatal Clinics in Nigeria. NASCP Abuja: Nigeria, November, 2008. p. 28.  Back to cited text no. 2
    
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