Lipid profile changes by high activity anti-retroviral therapy

ObjectiveStudy of the lipid profile in patients infected with HIV treated with different combinations of high activity anti-retroviral therapy (HAART).Design and methodsA retrospective cohort study of the lipid profile in patients undergoing HAART. The study analyzes the evolution of concentrations of triglycerides (TG), total cholesterol (TC), LDL-cholesterol (LDLc) and HDL-cholesterol (HDLc) in a period of at least 3 years of treatment. From a total of 750 clinical cases analyzed in Hospital Joaquim Urbano (Oporto, Portugal) 124 patients were selected for this study.ResultsAfter 3 years of treatment, we observed the development of dyslipidaemia by increases in TG (17%), TC (29%) and LDLc (9%), particularly in patients treated with a combination of drugs which included protease inhibitors (PI). Moreover, the non-nucleoside reverse transcriptase inhibitors (NNRTI) were associated with better lipid profile. The increase of 46% in HDLc was the most surprising finding.ConclusionsThe results indicate that patients with HAART have a more atherogenic lipidic profile with increased TC, LDLc and TG levels. Since the effectiveness of NNRTI is similar to that of PI, but with a smaller atherogenic profile, it should be the first choice drug to be selected in the HIV treatment.

► HIV infected patients on high activity anti-retroviral therapy (HAART) develop dyslipidemia or exacerbate pre-existing conditions.
► Contradicting the majority of published studies, the HAART also increased the HDL levels.
► Therapeutic schemes with NNRTI proved to be less atherogenic than those involving PI, but equally effective; therefore it should be the first choice in treatment of HIV infection.