Evolution of blood lipids and risk factors of dyslipidemia among people living with human immunodeficiency virus who had received first-line antiretroviral regimens for 3 years in Shenzhen

Background:Lipid abnormalities are prevalent among people living with human immunodeficiency virus(HIV)(PLWH)and contribute to increasing risk of cardiovascular events.This study aims to investigate the incidence of dyslipidemia and its risk factors in PLWH after receiving different first-line free antiretroviral regimens.Methods:PLWH who sought care at the Third People’s Hospital of Shenzhen from January 2014 to December 2018 were included,and the baseline characteristics and clinical data during the follow-up were collected,including total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C).The risk factors of dyslipidemia after antiretroviral therapy were analyzed with the generalized estimating equation model.Results:Among the 7623 PLWH included,the mean levels of TC,HDL-C and LDL-C were 4.23±0.85 mmol/L,1.27±0.29 mmol/L and 2.54±0.65 mmol/L,respectively,and the median TG was 1.17(IQR:0.85-1.68)mmol/L.Compared with that in PLWH receiving tenofovir disoproxil fumarate(TDF)+lamivudine(3TC)+ritonavir-boosted lopinavir(LPV/r),zidovudine(AZT)+3TC+efavirenz(EFV),and AZT+3TC+LPV/r,the incidence of dyslipidemia was lower in PLWH receiving TDF+3TC+EFV.In multivariate analysis,we found that the risks of elevations of TG,TC,and LDL-C were higher with TDF+3TC+LPV/r(TG:odds ratio[OR]=2.82,95%confidence interval[CI]:2.55-3.11,P<0.001;TC:OR=1.24,95%CI:1.14-1.35,P<0.001;LDL:OR=1.06,95%CI:1.00-1.12,P=0.041),AZT+3TC+EFV(TG:OR=1.41,95%CI:1.28-1.55,P<0.001;TC:OR=1.43,95%CI:1.31-1.56,P<0.001;LDL:OR=1.18,95%CI:1.12-1.25,P<0.001),and AZT+3TC+LPV/r(TG:OR=3.08,95%CI:2.65-3.59,P<0.001;TC:OR=2.40,95%CI:1.96-2.94,P<0.001;LDL:OR=1.52,95%CI:1.37-1.69,P<0.001)than with TDF+3TC+EFV,while treatment with TDF+3TC+LPV/r was less likely to restore HDL-C levels compared with TDF+3TC+EFV(OR=0.95,95%CI:0.92-0.97,P<0.001).In addition to antiretroviral regimens,antiretroviral therapy duration,older age,overweight,obesity and other traditional factors were also important risk factors for dyslipidemia.Conclusion:The incidence of dyslipidemia varies with different antiretroviral regimens,with TDF+3TC+EFV having lower risk for dyslipidemia than the other first-line free antiretroviral regimens in China.

NRTIs’ effect on the sequence of mitochondrial DNA HV 2 in HIV infected patients

Potent combination antiretroviral therapy(cART)has significantly improved the life expectancy of people living with human immunodeficiency virus(HIV),but it has many side effects such as lipodystrophy(LD),hepatic steatosis,and lactic acidosis.Nucleoside reverse transcriptase inhibitors(NRTIs)could damage the mito-chondria by inhibiting the human DNA polymerase gamma,leading to mtDNA deletion.However,it remains uncertain whether NRTIs could induce the hypervariable region(HV)mutations of the D loop of mitochondria in Chinese HIV/AIDS patients,and whether that effect is different between individuals with and without LD.Hereby,30 Chinese AIDS patients who were receiving antiretroviral drugs were recruited,among which 16 had symptomatic LD and 14 did not.Blood samples were collected prior to and after 96 weeks of treatment.Total DNA was extracted from peripheral blood mononuclear cells(PBMCs).Fragments of 728 bp in length containing HV 2 were amplified by standard polymerase chain reaction(PCR).Direct DNA-sequencing analysis techni-ques were used to detect mitochondrial sequence variants between paired longitudinal samples.Alterations were compared with the revised Cambridge Reference Sequence(rCRS)to determine mutation or polymorphism.Results showed that two years after ART,totally seven cases exhibited sequence variations,five individuals showed 73 A!G revised variation(two with and three without LD),while two cases of LD were found to have other nucleotide alterations.There was no new alteration in individuals without LD.In conclusion,NRTIs could induce mutation of mtDNA HV 2,which might contribute to the development of LD.