Evaluation of HIV therapeutic agents on immunological, lipid and lipoprotein indices in Ghanaian HIV-1 infected patients

Abstract

HIV-1 infected patients initiating antiretroviral therapy (ART) in Ghana are placed on one of the two most commonly used non-nucleoside reverse transcriptase inhibitors (NNRTIs), nevirapine (NVP) and efavirenz (EFV), in combination with a nucleoside reverse transcriptase inhibitor backbone of either combivir (CBV) or stavudine (d4T)/lamivudine (3TC). This study sought to evaluate the effect of these therapeutic agents on weight, immunological, lipid and lipoprotein changes as well as the atherogenic indices of Ghanaian HIV-1 infected patients. This observational study was carried out at the ART clinic of the Regional Hospital, Bolgatanga in the Upper-East region of Ghana from September 2008 to September 2009 comprising 61 HIV-1 infected patients who were initiated on NVP or EFV in combination with either CBV or d4T/3TC. Out of the 61 enrolled patients, 27(44.3%) were on NVP and 34(55.7%) were on EFV. Within the NVP group, 16 (59.3%) were on CBV and 11(40.7%) on d4T/3TC whilst the EFV group had 26(76.5%) on CBV and 8 (23.5%) on d4T/3TC. Percentage changes in lipid profile components comprising total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-c) and low density lipoprotein cholesterol (LDL-c) was assessed over the 12-month period. Percentage changes in atherogenic index expressed as TC/HDL-c and LDL-c/HDL-c was also estimated. NVP elicited a 10.2% increase in weight compared to EFV and this was associated with CBV combination use. EFV further elicited a 9.1% increase in TC, 1.2% increase in TG, 39.3% increase in LDL-c and a 4.1% increase in HDL-c which resulted in concomitant percentage increases in TC/HDL-c (22%) and LDL-c/HDL-c (47.3%). CBV as a NRTI component of EFV elicited a 4.3% increase in TC/HDL-c and a 16.6% increase in LDL-c/HDL-c compared to d4T/3TC whilst conversely, d4T/3TC elicited a 3.6% increase in TC/HDL-c and a 34.0% when used in combination with NVP. NVP combination therapy elicited improvement in weight compared to EFV combination therapy for the different categories of patients. The less atherogenic lipid profile observed in patients taking NVP in comparison to those taking EFV and the reduction in CHD risk associated with NVP + CBV combination therapy observed in this study should be factored into considerations taken when selecting the most appropriate ART regimen for treatment naïve HIV-1 infected patients.Journal of Medical and Biomedical Sciences (2016) 5(3), 13-27Keywords: HIV-1, Antiretroviral therapy, Immunological, Lipids, Atherogenic indices, Bolgatanga, Ghana