Dyslipidaemia and Intima-Media Thickness of Carotid Arteries in Thirty-Five HIV/AIDS Patients Receiving Highly Active Antiretroviral Therapy

摘要

Objectives: Highly active antiretroviral therapy (HAART) has being impacted significantly therapies fornatural human immunodeficiency virus (HIV) infection, which leads to a remarkable decrease in its morbidityand mortality but it is frequently associated with metabolic complications such as dyslipidaemia and cardio-vascular complications. HIV reverse transcriptase (RT) inhibitors can be classified into nucleoside and non-nucleoside types. Mitochondrial dysfunction due to the depletion of mt-DNA is partly responsible for variousnucleoside RT inhibitors-associated adverse effects including dyslipidaemia. Efavirenz (EFV) is metabolizedprimarily by cytochrome P450 2B6 (CYP2B6) and the metabolic effects of EFV have been described previously.All patients in this study received the same HAART treatment regime (Stavudine (d4T) + Lamivudine (3TC)+ Efavirenz (EFV)). This study aims to assess incidences for dyslipidaemia and atherosclerosis. Methods: Thisretrospective study was conducted within outpatients of Shanghai Public Health Center. We selected thirty-fiveHIV-1 infected patients who receiving highly active antiretroviral therapy. Their mean CD4 cell count was 69.5(±34.6) copies per micro liter before therapy. Fasting total cholesterol, triglyceride, high-density lipoprotein(HDL) cholesterol and low-density lipoprotein (LDL) cholesterol values were respectively compared amongpatients at present and before therapy. Then the data was statistically analyzed. Twenty-two patients had theintima-media thickness (IMT) of their carotid arteries measured by Philips 5000 Color-Doppler ultrasoundtests. Results: After therapy, patients achieved significant changes in levels of triglycerides (1.44 ± 0.35mmol/LVs. 2.07 ± 0.54mmol/L) (P<0.001), total cholesterol (4.96 ± 0.46 mmol/L Vs. 6.15 ± 0.83mmol/L) (P<0.001) andLDL cholesterol (2.29 ± 0.33 Vs. 3.11 ± 0.29 mmol/L) (P<0.001). In contrast, the level of HDL cholesterol didnot significantly change (1.06 0.01 mmol/L Vs. 1.04 ± 0.01 mmol/L) (P>0.5). The mean IMT of twenty-twopatients was (0.86 ± 0.14) mm after HAART, which is higher than the norm age-matched value of (0.7 ± 0.2)mm (P<0.05). Conclusion: These data suggest that HAART is potentially dangerous for hyperlipidaemia andmaybe an increase in atherosclerosis.