Dyslipidaemia in HIV-1-infected patients receiving protease inhibitors after initial treatment with first-line-based non-nucleoside reverse transcriptase inhibitors: a cross-sectional study

OBJECTIVES Lipid abnormalities associated with antiretroviral therapy in people with HIV infection are more frequent with protease inhibitors (PI)-based regimens. Whether effects extend to patients receiving a PI subsequent to failure on non-nucleoside reverse-transcriptase inhibitors (NNRTI)-based regimen is still unknown. We investigated the effects of secondary treatment with a PI on the lipid profile in a group of patients with HIV infection in Cameroon. DESIGN This was a cross-sectional study. SETTING This study was carried out at the registered centre for HIV treatment of the Yaounde Jamot Hospital in Cameroon. PARTICIPANTS Participants were consecutively recruited between November 2009 and January 2010. There were 138 HIV-1 patients on initial treatment with an NNRTI regimen and 66 HIV patients on secondary treatment with a PI for at least 12 months. Lipid abnormalities were based on the National Cholesterol Education Program, Adult Treatment Panel III criteria. OUTCOME MEASURES Levels of lipid parameters among patients on PI and NNRTI. RESULTS Median (IQR) levels (mg/dl), NNRTI-treated versus PI-treated patients were 185 (149-225) and 189 (147-244) for total cholesterol, 46 (27-66) and 42 (28-82) for high-density lipoprotein (HDL)-cholesterol, 121 (90-169) and 126.9 (71-176) for low-density lipoprotein (LDL)-cholesterol, 134 (98-174) and 138 (111-167) for triglycerides, and 4.3 (2.9-6.2) and 5.1 (2.6-7.9) for total/HDL-cholesterol ratio (all p>0.32). The most frequent lipid abnormality in the two groups was high LDL-cholesterol (46.4% (NNRTI) vs 54.5% (PI)). The occurrence of lipid abnormalities was similar in the two groups (all p>0.29). CONCLUSIONS The use of PI does not appear to deteriorate the lipid profile of HIV patients above and beyond abnormalities induced by an unsuccessful initial treatment with NNRTI. Monitoring of lipid profile during HIV treatment regardless of the regimens would improve timely detection and management of abnormalities, to mitigate related risks.