Dyslipidaemia in HIV-infected patients: association with adherence to potent antiretroviral therapy

Metabolic complications are being increasingly recognized among HIV-infecte d patients treated with potent combination antiretroviral therapies. We sou ght to assess the association of dyslipidaemia with adherence to protease i nhibitor (PI) therapy and with the markers of clinical response to antiretr oviral therapy (CD4 count, HIV RNA viral level) through a prospective, cros s-sectional cohort study. Fifty-six HIV-infected patients who were already on, or who were started on PI-containing antiretroviral therapy were monito red for the development of dyslipidaemias. Therapy with PI-containing antir etroviral therapy was significantly associated with elevated serum triglyce ride level ( > 250 mg/dl) (52% vs 8%, P=0.001). Patients with an adherence rate of at least 80% to a PI-containing regimen were significantly more lik ely to have elevated low density lipoprotein (LDL) cholesterol level as com pared to patients with an adherence rate of < 80% (79% vs 26%, P=0.03). Pat ients with an adherence rate of at least 80% to a PI-containing regimen wer e also significantly more likely to have severe hypertriglyceridaemia (> 80 0 mg/dl) as compared to patients with an adherence rate of < 80% (21% vs 4% , P=0.04). Viral load at the last study visit did not correlate with total cholesterol (r=-0.39, P=0.30), LDL cholesterol (r=0.57, P=0.30), or triglyc eride level (r=0.55, P=0.20). However, there was a significant correlation between the last viral load and high density lipoprotein (HDL) cholesterol (r=0.79, P=0.035), i.e. lower viral load was associated with higher HDL cho lesterol level. Tn conclusion, dyslipidaemia in patients with HIV infection was significantly associated with adherence to PI-containing antiretrovira l therapy. Patients who are adherent to PI-containing regimens at least 80% of the time warrant close monitoring for the development of dyslipidaemia.