TY - JOUR
T1 - Impact of NRTIs on lipid levels among a large HIV-infected cohort initiating antiretroviral therapy in clinical care
AU - Crane, Heidi M.
AU - Grunfeld, Carl
AU - Willig, James H.
AU - Mugavero, Michael J.
AU - Van Rompaey, Stephen
AU - Moore, Richard
AU - Rodriguez, Benigno
AU - Feldman, Betsy J.
AU - Lederman, Michael M.
AU - Saag, Michael S.
AU - Kitahata, Mari M.
PY - 2011/1/14
Y1 - 2011/1/14
N2 - Objective: To assess the associations between nucleoside reverse transcriptase inhibitors (NRTIs) and change in lipid levels among a large cohort of HIV-infected patients in routine clinical care initiating their first potent antiretroviral regimen. Design: Longitudinal observational cohort study from the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort. Methods: We used generalized estimating equations to examine the association between NRTIs and lipids accounting for within-patient correlations between repeated measures and key clinical and demographic characteristics including other antiretroviral medications. Results: Among 2267 individuals who started their first antiretroviral regimen, tenofovir with emtricitabine or lamivudine was associated with lower levels for total cholesterol, low-density lipoprotein (LDL), triglycerides, non-high-density lipoprotein (HDL), and HDL, compared with other NRTI pairs in adjusted analyses. LDL levels were highest among patients receiving didanosine/lamivudine. Triglyceride levels were highest in stavudine/lamivudine users. HDL levels were highest among patients receiving didanosine/stavudine. Hepatitis C infection and younger age were also associated with lower lipid levels. Conclusion: We found clinically important heterogeneity within the NRTI class of antiretroviral medications regarding their effect on lipid levels over time. Although the lipid profile of tenofovir with emtricitabine or lamivudine appeared to be less pro-atherogenic in this large longitudinal study of HIV-infected patients in routine clinical care, there was no association with beneficial HDL levels. In general, the change in lipid levels associated with most antiretroviral agents, particularly those NRTI combinations currently in common use, are relatively modest. Additional studies are needed to understand the long-term implications of these findings on cardiovascular disease risk.
AB - Objective: To assess the associations between nucleoside reverse transcriptase inhibitors (NRTIs) and change in lipid levels among a large cohort of HIV-infected patients in routine clinical care initiating their first potent antiretroviral regimen. Design: Longitudinal observational cohort study from the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort. Methods: We used generalized estimating equations to examine the association between NRTIs and lipids accounting for within-patient correlations between repeated measures and key clinical and demographic characteristics including other antiretroviral medications. Results: Among 2267 individuals who started their first antiretroviral regimen, tenofovir with emtricitabine or lamivudine was associated with lower levels for total cholesterol, low-density lipoprotein (LDL), triglycerides, non-high-density lipoprotein (HDL), and HDL, compared with other NRTI pairs in adjusted analyses. LDL levels were highest among patients receiving didanosine/lamivudine. Triglyceride levels were highest in stavudine/lamivudine users. HDL levels were highest among patients receiving didanosine/stavudine. Hepatitis C infection and younger age were also associated with lower lipid levels. Conclusion: We found clinically important heterogeneity within the NRTI class of antiretroviral medications regarding their effect on lipid levels over time. Although the lipid profile of tenofovir with emtricitabine or lamivudine appeared to be less pro-atherogenic in this large longitudinal study of HIV-infected patients in routine clinical care, there was no association with beneficial HDL levels. In general, the change in lipid levels associated with most antiretroviral agents, particularly those NRTI combinations currently in common use, are relatively modest. Additional studies are needed to understand the long-term implications of these findings on cardiovascular disease risk.
KW - HIV
KW - antiretroviral therapy
KW - cholesterol
KW - dyslipidemia
KW - lipid levels
KW - nucleoside reverse transcriptase inhibitors
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UR - http://www.scopus.com/inward/citedby.url?scp=78650902667&partnerID=8YFLogxK
U2 - 10.1097/QAD.0b013e328341f925
DO - 10.1097/QAD.0b013e328341f925
M3 - Article
C2 - 21150555
AN - SCOPUS:78650902667
SN - 0269-9370
VL - 25
SP - 185
EP - 195
JO - AIDS
JF - AIDS
IS - 2
ER -