Impact of antiretroviral therapy (ART), immunosuppression and viraemia on lipid levels: the D:A:D study


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Inproceedings: an article in a conference proceedings.
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Poster: Summary – with images – on one page of the results of a researche project. The summaries of the poster must be entered in "Abstract" and not "Poster".
Impact of antiretroviral therapy (ART), immunosuppression and viraemia on lipid levels: the D:A:D study
Title of the conference
11th International Congress on Drug Therapy in HIV Infection
Kamara D., Sabin C., Reiss P., Rickenbach M., Smith C., De Wit S., Law M., Mocroft A., Pradier C., Lundgren J.
Glasgow, United Kingdom, November 11-15, 2012
Publication state
Issued date
Journal of the International AIDS Society
Purpose of the study: To investigate the impact of ART, HIV viremia
and immunosuppression on triglyceride (TG), total cholesterol (TC)
and high density lipoprotein cholesterol (HDL-C) levels.
Methods: We considered the cross-sectional associations between
TG, TC and HDL-C (mmol/l; first available measurement on/after
enrolment in the D:A:D study) and use of ART, HIV viral load (VL;
copies/ml), and CD4 count (cells/mm3) measured at the same time.
TG was log10 transformed to ensure normality. Analyses were
performed using linear regression and adjusted for other factors
known to impact lipid levels (table footnote). ART and VL status were
combined (off ART&VL _100,000, off ART&VL B100,000, on
ART&VL B500, on ART&VL _500), current and nadir CD4 count
were categorised as B200, 200_349, 350_499 and _500.
Summary of results: 44,322/49,734 participants in the D:A:D Study
(89.1%) contributed a TG measurement (median; IQR 1.52; 1.00_
2.45), 45,169 (90.8%) a TC measurement (4.80; 4.00_5.70) and
38,604 (77.6%) a HDL-C measurement (1.12; 0.90_1.40). Most
participants were male (74%), of white ethnicity (51%), without
AIDS (78%), were not receiving lipid-lowering drugs (4%) and were
ART experienced (61%) with 47% previously exposed to PIs, 61%
previously exposed to NRTIs and 29% previously exposed to NNRTIs.
The median (IQR) age, current CD4 count and CD4 nadir were 38
(36_45) years, 400 (242_590) cells/ml and 240 (100_410) cells/ml
respectively. Compared to those on ART with a suppressed VL, all
lipids were lower for those off ART (Table); non-suppressive ART was
also associated with lower TC and HDL-C levels (no impact on TG). A
low current CD4 count was associated with lower lipid levels,
whereas a low nadir CD4 count was associated with higher TC and TG
levels. Prior AIDS diagnosis was associated with higher TG and TC,
but lower HDL-C levels.
Conclusion: Although specific drug classes were not considered, lipid
levels are considerably higher in those on a suppressive ART regimen.
The higher TC/TG and lower HDL-C levels seen among those with low
nadir CD4 count and with a prior AIDS diagnosis suggests severe
immunosuppression may be associated with dyslipidaemia over the
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17/01/2013 16:54
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