Factors affecting high-density lipoprotein cholesterol in HIV-infected patients on nevirapine-based antiretroviral therapy.

Padmapriyadarsini, C.; Ramesh, K.; Sekar, L.; Ramachandran, G.; Devaraj, R.; Narendran, G.; Sekar, S.; Chandrasekar, C.; Anbarasu, D.; Wanke, C.; Swaminathan, S.

Indian Journal of Medical Research; 2017; 145: 641-650.

Background & objectives : Cardiovascular disease (CVD) risk with low high-density lipoprotein cholesterol (HDL-C) and high triglycerides is common in the general population in India. As nevirapine (NVP)-based antiretroviral therapy (ART) tends to increase HDL-C, gene polymorphisms associated with HDL-C metabolism in HIV-infected adults on stable NVP-based ART were studied.

Methods : A cross-sectional study was conducted between January 2013 and July 2014 among adults receiving NVP-based ART for 12-15 months. Blood lipids were estimated and gene polymorphisms in apolipoprotein C3 ( APOC3 ), cholesteryl ester transfer protein ( CETP ) and lipoprotein lipase ( LPL ) genes were analyzed by real-time polymerase chain reaction. Framingham's 10-yr CVD risk score was estimated. Logistic regression was done to show factors related to low HDL-C levels.

Results : Of the 300 patients included (mean age: 38.6±8.7 yr; mean CD4 count 449±210 cell/µl), total cholesterol (TC) >200 mg/dl was observed in 116 (39%) patients. Thirty nine per cent males and 47 per cent females had HDL-C levels below normal while 32 per cent males and 37 per cent females had TC/HDL ratio of 4.5 and 4.0, respectively. Body mass index [adjusted odds ratio (aOR)=1.70, 95% confidence interval (CI) 1.01-2.84, P =0.04] and viral load (aOR=3.39, 95% CI: 1.52-7.52, P =0.003) were negatively associated with serum HDL-C levels. The 10-yr risk score of developing CVD was 11-20 per cent in 3 per cent patients. Allelic variants of APOC3 showed a trend towards low HDL-C.

Interpretation & conclusions : High-risk lipid profiles for atherosclerosis and cardiovascular disease were common among HIV-infected individuals, even after 12 months of NVP-based ART. Targeted interventions to address these factors should be recommended in the national ART programmes.

Keywords: Antiretroviral therapy; body mass index; gene polymorphisms; high-density lipoprotein-cholesterol; HIV; nevirapine; viral load

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