First-line antiretroviral therapy and dyslipidemia in people living with HIV-1 in Cameroon: a cross-sectional study

BACKGROUND: Data on lipid profile derangements induced by antiretroviral treatment in Africa are scarce. The aim of this study was to determine the prevalence and characteristics of lipid profile derangements associated with first-line highly active antiretroviral therapy (ART) among Cameroonians living with human immunodeficiency virus (HIV) infection. METHODS: This cross-sectional study was conducted between November 2009 and January 2010, and involved 138 HIV patients who had never received ART (ART-naive group) and 138 others treated for at least 12 months with first line triple ART regimens that included nevirapine or efavirenz (ART group). Lipid profile was determined after overnight fast and dyslipidemia diagnosed according to the US National Cholesterol Education Program III criteria. Data comparison used chi-square test, Student t-test and logistic regressions. RESULTS: The prevalence of total cholesterol [greater than or equal to] 200 mg/dl was 37.6% and 24.6% respectively in ART group and ART-naive groups (p = 0.019). The equivalents for LDL-cholesterol [greater than or equal to] 130 mg/dl were 46.4% and 21% (p [less than or equal to] 0.001). Proportions of patients with total cholesterol/HDL-cholesterol ratio [greater than or equal to] 5 was 35.5% in ART group and 18.6% in ART-naive group (p [less than or equal to] 0.001). The distribution of HDL-cholesterol and triglycerides was similar between the two groups. In multivariable analysis adjusted for age, sex, body mass index, CD4 count and co-infection with tuberculosis, being on ART was significantly and positively associated with raised total cholesterol, LDL-cholesterol and TC/HDL cholesterol. The adjusted odd ratios (95% confidence interval, p-value) ART-treated vs. ART-naive was 1.82 (1.06-1.12, p = 0.02) for TC [greater than or equal to] 200 mg/dl; 2.99 (1.74-5.15), p < 0.0001) for LDL-cholesterol [greater than or equal to] 130 mg/dl and 1.73 (1.04-2.89, p = 0.03) for TC/HDL-cholesterol [greater than or equal to] 5. CONCLUSIONS: First-line antiretroviral therapy that includes nonnucleoside reverse transcriptase inhibitors is associated with pro-atherogenic adverse lipid profile in people with HIV-1 infection compared to untreated HIV-infected subjects in Yaounde. Lipid profile and other cardiovascular risk factors should be monitored in patients on such therapy so that any untoward effects of treatments can be optimally managed.