Prevalence of Dyslipidemia and Metabolic Abnormalities in HIV-Infected Patients

  • Amitis Ramezani Mail Department of Clinical Research, Pasteur Institute of Iran, Tehran, Iran. AND Infectious Diseases Research Center, School of Medicine, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
  • Minoo Mohraz Iranian Research Center for HIV/AIDS, Tehran, Iran.
  • Davood Yadegarinia Infectious Diseases Research Center, School of Medicine, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
  • Mohammad Banifazl Iranian society for Support Patients with Infectious Disease, Tehran, Iran.
  • Latif Gachkar Infectious Diseases Research Center, School of Medicine, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
  • Sara Jam Iranian Research Center for HIV/AIDS, Tehran, Iran.
  • Arezoo Aghakhani Department of Clinical Research, Pasteur Institute of Iran, Tehran, Iran.
  • Ali Eslamifar Department of Clinical Research, Pasteur Institute of Iran, Tehran, Iran.
  • Farhad Yaghmaie Health Deputy of Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
  • Kambiz Nemati North of Tehran Health Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
  • Ali Akbar Velayati Masih Daneshvari Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
Keywords:
Dyslipidemia, lactate, hyperglycemia, HIV, protease inhibitors, HAART

Abstract

Dyslipidemia has become a common problem in human immunodeficiency virus (HIV) disease, especially in patients on combination antiretroviral therapy. We investigated the prevalence of and factors associated with dyslipidemia in HIV-infected patients in Iran. In this cross-sectional study, 190 HIV positive patients who referring to behavioral disease consulting centers (Shemiranat, Varamin) and Iranian Research Center for HIV/AIDS in Tehran, were studied from December 2005 to December 2006.A standardized questionnaire with epidemiological, clinical, and therapeutic data was completed by physicians. Blood samples were obtained for metabolic measurements. CD4 cell count was measured by flow cytometry. Levels of total cholesterol, triglycerides, and lactate were elevated in 16.9%, 29.9%, and 22.5% of patients, respectively. The prevalence of elevated triglyceride and cholesterol levels was significantly higher among patients receiving antiretroviral therapy than it was among those who were not receiving treatment. Fasting hyperglycemia was noted in 10.1% of patients overall, but this was not significantly associated with antiretroviral treatment group. Low HDL levels were noted in 52.4% of patients overall, and this finding did not vary by treatment group. There is a high prevalence of dyslipidemia in patients taking antiretroviral therapy in Iran. We conclude that the prevalence of and factors associated with metabolic abnormalities in HIV-infected Iranian patients are similar to those reported for Western and Asian studies.

References

Zarocostas J. Number of people infected with HIV worldwide reaches 40m. BMJ 2005; 331(7527): 1224.

Qaqish RB, Fisher E, Rublein J, Wohl DA. HIV-associated lipodystrophy syndrome. Pharmacotherapy 2000; 20(1): 13-22.

Cohan GR. HIV-associated metabolic and morphologic abnormality syndrome: Welcome therapy may have unwelcome effects. Postgrad Med 2000; 107(4): 141-6.

Green ML. Evaluation and management of dyslipidemia in patients with HIV infection. J Gen Intern Med 2002; 17(10): 797-810.

Struble K, Piscitelli SC. Syndromes of abnormal fat redistribution and metabolic complications in HIV-infected patients. Am J Health Syst Pharm 1999; 56(22): 2343-8.

Behrens G, Dejam A, Schmidt H, Balks HJ, Brabant G, Körner T, et al. Impaired glucose tolerance, beta cell function and lipid metabolism in HIV patients under treatment with protease inhibitors. AIDS 1999; 13(10): F63-70.

Chang E, Deleo M, Liu YT, Tetreault D, Beall G; International Conference on AIDS. The effects of antiretroviral protease inhibitors on serum lipids and glucose in HIVinfected patients. 12th International Conference on AIDS. Int Conf AIDS 1998; 12: 89-90.

Wanke CA. Epidemiological and clinical aspects of the metabolic complications of HIV infection the fat redistribution syndrome. AIDS 1999; 13(11): 1287-93.

Morse CG, Kovacs JA. Metabolic and skeletal complications of HIV infection: the price of success. JAMA 2006; 296(7): 844-54.

Barbaro G. Metabolic and cardiovascular complications of highly active antiretroviral therapy for HIV infection. Curr HIV Res 2006; 4(1): 79-85.

Leclercq P, Blanc M. Metabolic abnormalities, lipodystrophy and cardiovascular risk in HIV-infected patients. Rev Prat 2006; 56(9): 987-94.

Paton NI, Earnest A, Ng YM, Karim F, Aboulhab J. Lipodystrophy in a cohort of human immunodeficiency virusinfected Asian patients: prevalence, associated factors, and psychological impact. Clin Infect Dis 2002; 35(10): 1244-9.

Carr A, Samaras K, Thorisdottir A, Kaufmann GR, Chisholm DJ, Cooper DA. Diagnosis, prediction, and natural course of HIV-1 protease-inhibitor-associated lipodystrophy, hyperlipidaemia, and diabetes mellitus: a cohort study. Lancet 1999; 353(9170): 2093-9.

Heath KV, Hogg RS, Chan KJ, Harris M, Montessori V, O'Shaughnessy MV, et al. Lipodystrophy-associated morphological, cholesterol and triglyceride abnormalities in a population-based HIV/AIDS treatment database. AIDS 2001; 15(2): 231-9.

Lichtenstein KA, Ward DJ, Moorman AC, Delaney KM, Young B, Palella FJ Jr, et al. Clinical assessment of HIVassociated lipodystrophy in an ambulatory population. AIDS 2001; 15(11): 1389-98.

Martinez E, Mocroft A, García-Viejo MA, Pérez-Cuevas JB, Blanco JL, Mallolas J, et al. Risk of lipodystrophy in HIV-1-infected patients treated with protease inhibitors: a prospective cohort study. Lancet 2001; 357(9256): 592-8.

Thiébaut R, Daucourt V, Mercié P, Ekouévi DK, Malvy D, Morlat P, et al. Lipodystrophy, metabolic disorders, and human immunodeficiency virus infection: Aquitaine Cohort, France, 1999. Groupe d'Epidémiologie Clinique du Syndrome d'Immunodéficience Acquise en Aquitaine. Clin Infect Dis 2000; 31(6): 1482-7.

Pujari SN, Dravid A, Naik E, Bhagat S, Tash K, Nadler JP, et al. Lipodystrophy and dyslipidemia among patients taking first-line, World Health Organization-recommended highly active antiretroviral therapy regimens in Western India. J Acquir Immune Defic Syndr 2005; 39(2): 199-202.

Friis-Møller N, Weber R, Reiss P, Thiébaut R, Kirk O, d'Arminio Monforte A, et al. Cardiovascular disease risk factors in HIV patients: association with antiretroviral therapy. Results from the DAD study. AIDS 2003; 17(8): 1179-93.

Tomazic J, Silic A, Karner P, Vidmar L, Maticic M, Poljak M, et al. Lipodystrophy and metabolic abnormalities in Slovenian HIV-infected patients. Wien Klin Wochenschr 2004; 116(21-22): 755-9.

Pujol RM, Domingo P, Xavier-Matias-Guiu, Francia E, Sanbeat MA, Alomar A, et al. HIV-1 protease inhibitorassociated partial lipodystrophy: clinicopathologic review of 14 cases. J Am Acad Dermatol 2000; 42(2 Pt 1): 193-8.

Panse I, Vasseur E, Raffin-Sanson ML, Staroz F, Rouveix E, Saiag P. Lipodystrophy associated with protease inhibitors. Br J Dermatol 2000; 142(3): 496-500.

Echevarria KL, Hardin TC, Smith JA. Hyperlipidemia associated with protease inhibitor therapy. Ann Pharmacother 1999; 33(7-8): 859-63.

Koppel K, Bratt G, Eriksson M, Sandström E. Serum lipid levels associated with increased risk for cardiovascular disease is associated with highly active antiretroviral therapy (HAART) in HIV-1 infection. Int J STD AIDS 2000; 11(7): 451-5.

García-Benayas T, Blanco F, de la Cruz JJ, Senchordi MJ, Gómez-Viera JM, Soriano V, et al. Role of nonnucleosides in the development of HAART-related lipid disturbances. J Acquir Immune Defic Syndr 2001; 28(5): 496-8.

Manfredi R, Chiodo F. Disorders of lipid metabolism in patients with HIV disease treated with antiretroviral agents: frequency, relationship with administered drugs, and role of hypolipidaemic therapy with bezafibrate. J Infect 2001; 42(3): 181-8.

Behrens G, Dejam A, Schmidt H, Balks HJ, Brabant G, Körner T, et al. Impaired glucose tolerance, beta cell function and lipid metabolism in HIV patients under treatment with protease inhibitors. AIDS 1999; 13(10): F63-70.

Carr A, Samaras K, Burton S, Law M, Freund J, Chisholm DJ, et al. A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors. AIDS 1998; 12(7): F51-8.

Segerer S, Bogner JR, Walli R, Loch O, Goebel FD. Hyperlipidemia under treatment with proteinase inhibitors. Infection 1999; 27(2): 77-81.

Vergis EN, Paterson DL, Wagener MM, Swindells S, Singh N. Dyslipidaemia in HIV-infected patients: association with adherence to potent antiretroviral therapy. Int J STD AIDS 2001; 12(7): 463-8.

Tanwani LK, Mokshagundam SL Lipodystrophy, Insulin Resistance,Diabetes Mellitus, Dyslipidemia, and Cardiovascular Disease in Human Immunodeficiency Virus Infection South Med J 2003 Feb;96(2):180-188; quiz 189.

Sudano I, Spieker LE, Noll G, Corti R, Weber R, Luscher TF. Cardiovascular disease in HIV infection Am Heart J 2006 Jun; 151(6):1147-1155.

Rimland D, Guest JL, Hernández-Ramos I, Del Rio C, Le NA, Brown WV. Antiretroviral therapy in HIV-positive women is associated with increased apolipoproteins and total cholesterol. J Acquir Immune Defic Syndr 2006; 42(3): 307-13.

Muise A, Arbess G. The risk of myocardial infarction in HIV-infected patients receiving HAART: a case report. Int J STD AIDS 2001; 12(9): 612-3.

Eriksson U, Opravil M, Amann FW, Schaffner A. Is treatment with ritonavir a risk factor for myocardial infarction in HIV-infected patients? AIDS 1998; 12(15): 2079-80.

Tsiodras S, Mantzoros C, Hammer S, Samore M. Effects of protease inhibitors on hyperglycemia, hyperlipidemia, and lipodystrophy: a 5-year cohort study. Arch Intern Med 2000; 160(13): 2050-6.

Hadigan C, Meigs JB, Corcoran C, Rietschel P, Piecuch S, Basgoz N, et al. Metabolic abnormalities and cardiovascular disease risk factors in adults with human immunodeficiency virus infection and lipodystrophy. Clin Infect Dis 2001; 32(1): 130-9.

John M, Moore CB, James IR, Nolan D, Upton RP, McKinnon EJ, et al. Chronic hyperlactatemia in HIVinfected patients taking antiretroviral therapy. AIDS 2001; 15(6): 717-23.

Lonergan JT, Behling C, Pfander H, Hassanein TI, Mathews WC. Hyperlactatemia and hepatic abnormalities in

human immunodeficiency virus-infected patients receiving nucleoside analogue combination regimens. Clin Infect Dis 2000; 31(1): 162-6.

Harris M, Tesiorowski A, Chan K, Hogg R, Rosenberg R,Chan Yan C, et al. Lactic acidosis complicating antiretroviraltherapy: frequency and correlates. Antivir Ther 2000, 5(Suppl 2): 31.

Calza L, Manfredi R, Chiodo F. Hyperlactataemia and lactic acidosis in HIV-infected patients receiving antiretroviral therapy. Clin Nutr 2005; 24(1): 5-15.

Bonnet F, Balestre E, Bernardin E, Pellegrin JL, Neau D, Dabis F; Groupe d'Epidémiologie Clinique du SIDA en Aquitaine. Risk factors for hyperlactataemia in HIVinfected patients, Aquitaine Cohort, 1999-2003. AntivirChem Chemother 2005; 16(1): 63-7.

Huynh TK, Lüttichau HR, Roge BT, Gerstoft J. Natural history of hyperlactataemia in human immunodeficiency virus-1-infected patients during highly active antiretroviral therapy. Scand J Infect Dis 2003; 35(1): 62-6.

Vrouenraets SM, Treskes M, Regez RM, Troost N, Smulders YM, Weigel HM, et al. Hyperlactataemia in HIVinfected patients: the role of NRTI-treatment. Antivir Ther 2002; 7(4): 239-44.

Gérard Y, Maulin L, Yazdanpanah Y, De La Tribonnière X, Amiel C, Maurage CA, et al. Symptomatic hyperlactataemia: an emerging complication of antiretroviral therapy. AIDS 2000; 14(17): 2723-30.

Moyle GJ, Datta D, Mandalia S, Morlese J, Asboe D, Gazzard BG. Hyperlactataemia and lactic acidosis during antiretroviral therapy: relevance, reproducibility and possiblerisk factors. AIDS 2002; 16(10): 1341-9.

Boubaker K, Flepp M, Sudre P, Furrer H, Haensel A, Hirschel B, et al. Hyperlactatemia and antiretroviral therapy: the Swiss HIV Cohort Study. Clin Infect Dis 2001; 33(11): 1931-7.

How to Cite
1.
Ramezani A, Mohraz M, Yadegarinia D, Banifazl M, Gachkar L, Jam S, Aghakhani A, Eslamifar A, Yaghmaie F, Nemati K, Velayati AA. Prevalence of Dyslipidemia and Metabolic Abnormalities in HIV-Infected Patients. Acta Med Iran. 47(2):83-88.
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