Dyslipidemia among HIV-infected tuberculosis patients taking once-daily non-nucleoside reverse transcriptase inhibitor based antiretroviral therapy in India

Background. The effects of antiretroviral therapy (ART) on plasma lipid levels among HIV-infected individuals in India remain largely unknown.;Aims. To study the incidence and pattern of dyslipidemia among HIV-infected patients with tuberculosis (TB), receiving once-daily non-nucleoside reverse transcriptase inhibitor (NNRTI) based ART.;Methods. From May 2006 to June 2008, antiretroviral-naive HIV-infected TB patients were started on standard rifampicin based thrice weekly antituberculosis treatment (2EHRZ3/4RH3), at Tuberculosis Research Centre, India. Two months later, patients were randomized to receive didanosine (250/400mg) and lamivudine (300mg) with either Efavirenz (600mg) or Nevirapine (400mg) once-daily. Fasting blood samples were analyzed for blood glucose, triglycerides (TG), total cholesterol (TC), low-density cholesterol (LDL-c) and high-density cholesterol (HDL-c) at baseline, 6 and 12 months after ART.;Results. Of the 168 patients evaluated (79% men, mean age=36 years, weight=42kgs, median CD4 count=93 cells/mm3), 104 were on efavirenz and 64 on nevirapine-based ART regimen. After 6 months of ART, TC increased by 49 mg/dl, LDL-c by 30 mg/dl while HDL-c increased by 18 mg/dl from baseline (p 200 mg/dl for 1% and 26% of patients, LDL-c >130 mg/dl for 3% and 23%, HDL-c 110 mg/dl for 14% and 13% of patients. The proportion of patients with TC > 200mg/dl was significantly higher among patients on efavirenz than on nevirapine (32% vs 16%, p=0.04).;Conclusion. HIV-infected patients with TB initiating NNRTI-based ART, especially efavirenz, undergo changes in lipid levels and 25% have dyslipidemia after 1 year. It would be important to screen and treat for other risk factors in order to reduce the risk of cardiovascular disease in this population.