Effect of Antiretroviral Therapy on Section Circulating Lipid Levels in Human Immunodeficiency Virus Infected Patients: A Cross-sectional Study

Abstract

Introduction: The antiretroviral drugs have improved the quality and extent of life of Human Immunodeficiency Virus (HIV) infected patients, yet like any other long-term medication, these are known to cause several adverse effects. One such adverse effect is on the lipid metabolism in individuals on Antiretroviral Therapy (ART). Aim: To analyse the effect of ART on the circulating lipid levels in HIV patients. The secondary aim was to compare the lipid changes in patients treated with ZLN (Zidovudine+ Lamivudine+Nevirapine) drug regimen against those with TLE (Tenofovir+ Lamivudine+ Efavirenz). Materials and Methods: This cross-sectional study was conducted from December 2019 to March 2021 at the District Hospital, Chamarajanagar Karnataka, India. A total of 200 HIV positive patients between 18-55 years of age with no associated co-morbidities and who have been on ART were recruited into this study. Of the total 91 patients were on TLE (Tenofovir+ Lamivudine+ Efavirenz) and 109 were on ZLN (Zidovudine+ Lamivudine+Nevirapine) regimen. Blood samples were collected from all the patients and lipid profile analysis was done. Results: Statistically significant increase was observed in all lipid parameters in the ZLN group compared to TLE group. Serum Total Cholesterol (TC) {ZLN 190.92±43.57 v/s 164.23±40.7 in TLE group (p-value<0.0001)} serum Low-Density Lipoprotein Cholesterol (LDL-C) {ZLN 120.44±35.46 v/s 100.81±26.84 in TLE group (p-value<0.0001)}, Triglyceride (TG) {ZLN 245.68±132.42 v/s 171.56±77.30 in TLE group (p-value<0.0001)} and High Density Lipoprotein Cholesterol (HDL-C) {ZLN 60.71±17.51 v/s 53.31±13.8 in TLE group (p-value=0.0012)}. Also the non HDL-C levels {ZLN 130.2±39.51 v/s 110.91±36.87 in TLE group (p-value<0.0005)} were higher in patients receiving ZLN drug regimen than those who were on TLE. Of the 200 HIV patients, 53 were taking ART for less than 5 years (mean 2.51±1.12 years), 109 were receiving ART between 5-10 years (mean 7.78±1.50 years), 38 patients were on ART treatment for more than 10 years (mean 11.73±0.76 years). A positive significant association between lipid derangement and disease/ART duration was observed. Conclusion: Lipid abnormalities were more in HIV patients on ZLN drug regimen than those on TLE regimen. The longer course of disease/ART is associated with imminent lipoprotein derangement. Periodic monitoring of lipid levels are recommended in these patients.