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Read Pdf Copy Journal of the International Association of Providers of AIDS Care (JIAPAC) http://jia.sagepub.com/ Dyslipidemia in ART-Naive HIV-Infected Persons in Nigeria−−Implications for Care Modupe Akinrele Kuti, Olubukola Adeponle Adesina, Oluwatosin Alaba Awolude, Babatunde Oluwatosin Ogunbosi, Samuel Adetona Fayemiwo, Joshua Odunayo Akinyemi, Adedotun Adeyinka Adetunji, Achiaka Emmanuelle Irabor, Georgina Njideka Odaibo, Okonkwo Prosper, Babafemi Olapoju Taiwo, David Olaleye, Robert L. Murphy, Phyllis Kanki and Isaac Folorunso Adewole Journal of the International Association of Providers of AIDS Care (JIAPAC) published online 20 October 2014 DOI: 10.1177/2325957414555227 The online version of this article can be found at: http://jia.sagepub.com/content/early/2014/10/15/2325957414555227 Published by: http://www.sagepublications.com On behalf of: International Association of Physicians in AIDS Care Additional services and information for Journal of the International Association of Providers of AIDS Care (JIAPAC) can be found at: Email Alerts: http://jia.sagepub.com/cgi/alerts Subscriptions: http://jia.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav >> OnlineFirst Version of Record - Oct 20, 2014 What is This? Downloaded from jia.sagepub.com by guest on October 21, 2014 Original Manuscript Journal of the International Association of Providers of AIDS Care 1–5 Dyslipidemia in ART-Naive HIV-Infected ª The Author(s) 2014 Reprints and permission: Persons in Nigeria—Implications for Care sagepub.com/journalsPermissions.nav DOI: 10.1177/2325957414555227 jiapac.sagepub.com Modupe Akinrele Kuti1, Olubukola Adeponle Adesina2, Oluwatosin Alaba Awolude2, Babatunde Oluwatosin Ogunbosi3, Samuel Adetona Fayemiwo4, Joshua Odunayo Akinyemi5, Adedotun Adeyinka Adetunji6, Achiaka Emmanuelle Irabor6, Georgina Njideka Odaibo7, Okonkwo Prosper8, Babafemi Olapoju Taiwo9, David Olaleye7, Robert L. Murphy9, Phyllis Kanki10, and Isaac Folorunso Adewole2 Abstract Aims: This study aimed to describe the prevalence and pattern of lipid abnormalities among antiretroviral therapy (ART)- naive HIV patients, understand if there is any relationship to virologic and immunologic status, and discuss the implications for care. Methods: This was a cross-sectional study in which baseline demographic, clinical, and laboratory data of all ART-naive HIV-infected individuals recruited into the adult ARV clinic, University College Hospital, Ibadan, between January and December 2006, were analyzed. Results: In total, 1316 ART-naive HIV-infected persons were recruited in the period. Females subjects and participants aged Ϲ35 years accounted for 67.1% and 57.7% of all participants, respectively. At least 1 abnormal lipid fraction was seen in 73.3% of participants. It was observed that in 11.5% participants the total cholesterol (TC) was м5.2 mmol/L, in 2.7% the low-density lipoprotein cholesterol (LDL)-C was >4.1 mmol/L in 56.5% the high-density lipoprotein cholesterol (HDL)-C was <1.0 mmol/L, and in 27.6% the triglyceride (TG) was >1.7 mmol/L. The TC, LDL-C, and HDL-C were all significantly positively correlated with CD4 counts and negatively correlated with viral load. On the con- trary, the TG levels were negatively correlated with CD4 counts and positively correlated with viral load. Multivariate lin- ear analysis showed a significant relationship between all the lipid parameters and viral load. CD4 counts were only significantly associated with TC. Conclusions: A significant burden of dyslipidemia exists among ART-naive HIV-infected per- sons. Low HDL-C was the most frequently observed abnormality. The abnormalities related more with viral load levels than with CD4 counts. Dyslipidemia screening should be done in ART-naive HIV-infected persons. Simple healthy lifestyle changes should be emphasized, with other care given to those with the disorder. Keywords HIV, lipids, HAART naive 1 Department of Chemical Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria 2 Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria 3 Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria 4 Department of Medical Microbiology, College of Medicine, University of Ibadan, Ibadan, Nigeria 5 Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria 6 Department of Family Medicine, University College Hospital, Ibadan, Nigeria 7 Department of Virology, College of Medicine, University of Ibadan, Ibadan, Nigeria 8 AIDS Prevention Iniative in Nigeria (APIN), Abuja, Nigeria 9 Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA 10 Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA Corresponding Author: Modupe Akinrele Kuti, Department of Chemical Pathology, College of Medicine, University of Ibadan, Ibadan. Email: [email protected] Downloaded from jia.sagepub.com by guest on October 21, 2014 2 Journal of the International Association of Providers of AIDS Care Introduction Data Collection Sub-Saharan Africa remains the region of the world that is Initial clinical assessment included obtaining a medical and most heavily affected by HIV. In 2010, the total number of medication history and a complete physical examination. Ini- people living with the disease in the region was estimated at tial laboratory investigation included a full blood count and 22.9 million, representing about 67% of the global burden blood chemistries (alanine transaminase, urea, glucose, creati- of the disease.1 About 10.4 million of these individuals were nine, and a complete lipid profile). All enrolled patients were estimated to be eligible for antiretroviral therapy (ART), required to have sputum and chest X-ray examination for tuber- with the lifesaving ART based on World Health Organiza- culosis, baseline CD4 count (cells/mm3), and HIV-1 RNA load. tion 2010 guidelines. However, with ART coverage in the A consent was obtained for data repository for future studies as region at about 49%, only about 5 million will receive the approved by the institutional review board of the University of therapy.1 In essence, about 18 million (78%) individuals liv- Ibadan/University College Hospital, Ibadan, Nigeria. The base- ing with HIV/AIDS in the region will not be on any antire- line data used for this study were those of all consenting ART- troviral (ARV) agent. naive HIV-positive individuals recruited into the clinic between In the absence of ART, the natural course of the HIV infec- January and December 2006. tion is characterized by viral replication and a slow but progres- 2 sive destruction of the immune system. Stimulation by the Laboratory Analysis proliferating HIV antigens results in the almost pathognomonic feature of progressive HIV infection, that is, chronic immune Fasting blood samples were collected into tubes containing activation.3 This is characterized by polyclonal B-cell activa- potassium ethylenediaminetetraacetic acid and fluoride oxalate tion; increased T-cell turnover; increased frequencies of T cells for the measurement of lipids and glucose, respectively. Plasma with an activated phenotype; and increased levels of the proin- total cholesterol (TC), high-density lipoprotein cholesterol flammatory cytokines such as interleukin (IL)-1, IL-6, IL-8, (HDL-C), triglycerides (TGs), and glucose estimations were and tumor necrosis factor-a(TNF-a)].3 The production of these done using a Roche Hitachi 902 auto-analyzer (Roche Diag- cytokines is believed to contribute to the progression of the dis- nostics Co, Indianapolis, IN) and standard Roche enzymatic ease by activating HIV-1 replication and maintenance of active kits (Roche Diagnostics, Basel, Switzerland). Low-density HIV-1 expression.4 lipoprotein cholesterol (LDL-C) was calculated using the Frie- The profile of cytokine production described above has dewald formula (LDL—C in mmol/L ¼ TC in mmol/L À been known to induce insulin resistance. This induction is [HDL-C in mmol/L, þ TGs in mmol/L/5]. CD4 counts were thought to occur through a variety of mechanisms including measured using Partec Cyflow (Partec GmBH, Munster, Ger- the ability of these cytokines to cause increased lipolysis many) and HIV-RNA viral load with Roche Amplicor HIV-1 with the release of free fatty acids and inhibition of insulin version 1.5 (Roche Diagnostics, GmbH, Mannheim, Germany). receptor substrate 1 function with sequestration of the cyto- Cholesterol goals were defined as recommended by the Infec- solic glucose transporter 4.5 The manifestation of these tious Disease Society of America (IDSA) and the Adult AIDS effects includes lipid metabolism disorder. In this study, Clinical Trials Group (AACTG). we describe the prevalence and pattern of lipid abnormal- ities among ART-naive HIV-infected patients, define the Statistical Analysis relationship to their virologic and immunologic status, and Statistical analyses were done using Statistical Package for discuss any implications for care. Social Sciences, version 17. Descriptive statistics are reported as means with standard deviation (SD) and median with inter- quartile range. Means were compared using the Student t test, Materials and Methods medians were compared using the Mann-Whitney U test, while proportions were compared using the chi-square test. Spearman Patient Population correlation coefficient was used to assess
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