Serum triglycerides, HIV infection, and highly active antiretroviral therapy, Aquitaine Cohort, France, 1996 to 1998

The aim of this study was to identify factors associated with serum triglyc eride (TG) evolution in HIV-1-infected patients when highly active antiretr oviral treatment (HAART) with or without protease inhibitors (PI) was intro duced. Among 3191 patients of the Aquitaine Cohort (multirisk, both genders , multiple treatment patterns) observed during 1996 through 1998, 1429 had at least two measurements of TG, vital load, and CD4 cell count. Median fol low-up was 21 months (interquartile range [IQR], 11-26) and median number o f TG measures was 6 (IQR, 3-10). Median TG at baseline was 1.32 mmoy/L (IQR , 0.91-2.05) and increased significantly over time (+2.5% for 100 days; 95% confidence interval [CI], 1.9-3.1). Longitudinal analysis of variations of TG was performed using mixed models. In crude analysis, baseline TG was hi gher in men, in those aged over 36 years, and in homosexuals. The following time-dependent variables were associated with an increase of TG: body weig ht increasing to >65 kg, diagnosis of AIDS, CD4 cell count falling to <50 c ells/mm(3), viral load falling to <500 cp/ml, and introduction of nucleosid e analogues and PIs. In multivariate analysis, age >36 years (change of +17 % of the TG level; 95% CT, 11-24), homosexuals (+13%; 95% CI, 4-23), AIDS s tage (+12%; 95% CI, 5-19), weight >65 kg (+7%; 95% CI, 2-12) and PI (+21%; 95% CI, 17-27) remained significant. Factors identified before the availabi lity of PI remain important but HAART with PI is a new major contributing f actor to increased TG levels.