Comparison of glucose and lipid abnormalities in HIV-infected patients on stavudine and zidovudine –based antiretroviral regimens at the Infectious Disease Clinic

Abstract

Background: HIV-infected patients treated with antiretroviral medications develop undesirable changes in lipid and glucose metabolism and may be prone to atherogenesis. The comparisons of glucose and lipid abnormalities among patients on W.H.O recommended, first-line ART combinations for Uganda and low income countries, where routine laboratory baseline and monitoring are not performed due to resource constraints, were critical to long-term management of ART. Objective: To compare the prevalence of and factors associated with glucose and lipid profile abnormalities among HIV-infected patients taking Stavudine-containing antiretroviral therapy (ART) with those taking zidovudine- containing regimens at the infectious disease clinic (IDC).- Mulago hospital . Methods: Patients on first-line antiretroviral therapy (ART) for >12 months without known diabetes were enrolled at the Adult Infectious Diseases Institute clinic (AIDC). Sociodemographic, baseline CD4 counts, WHO clinical stage, Initial weight, Peak body weight during ART data were abstracted from patients Chart. Anthropometric measurements and a targeted physical exam for lipodystrophy were performed. Fasting glucose and lipid profiles were measured to calculate the proportion of patients with abnormal glucose and lipid profile, total cholesterols (TC), low density lipoprotein (LDL), triglycerides (TG) and high density lipoprotein (HDL). Bivariate and multivariate logistic regression analyses were used to study the association between socio-demographic ,clinical characteristics and lipid and glucose abnormalities. Results: Four hundred forty one patients on ART were screened between May-August, 2008. Of these 422 patients were enrolled, 206(49%) patients on stavudine [d4T]-based therapy (median duration of ART 126 weeks) and 216(51%) on zidovudine [AZT]-based regimens (median xii duration 130 weeks). Prevalence of abnormal fasting glucose for d4T-based and AZT-based groups were 12.6% (26/206) and 19.0% (41/216) respectively (OR 0.62, 95% CI 0.35-1.8). Prevalence of lipid abnormalities for d4T-based and AZT-based were 91.26% (188/206) and 70.63% (153/216) respectively (OR 4.3 p-value P<0.001 95% CI 2.39-8.03). All elements of the lipid profile were statistically significantly abnormal in a greater proportion of patients taking d4T compared to AZT in the respective order; elevated total cholesterols (TC) were 43.7%[90/206] and 32.4%[70/216]; elevated low density lipids (LDL) 22.8%[47/206] and 13.9%[30/216]; elevated triglycerides(TG) 27.2%[56/206] and 17.6%[38/216]; depressed high density lipids (HDL)78.2%[161/206] and 44.0%[95/216]. Age ≥ 40 years and BMI >24.9kg/m2 and lipodystrophy were independently associated were hyperglycaemia in stavudine and zidovudine-based regimens respectively. Lipodystrophy was the only factor associated with lipid abnormalities among patients on stavudine. No factor was associated with lipid abnormalities among patients on zidovudine. Conclusion: HIV/AIDS patients on thymidine nucleoside analogues for 12 months and above are associated with high prevalence of lipid abnormalities. Patients on stavudine-based ART were more likely to develop lipid abnormalities compared with zidovudine-based regimens. Presence of lipodystrophy associated with lipid abnormalities in both stavudine and zidovudinebased regimen. HIV-infected patients on AZT-based regimen were more likely to develop glucose abnormalities compared to D4T-based group .Traditional risk factors such advanced age, excess weight are associated with hyperglycaemia in zidovudine –based regimen. Recommendation: Approaches to clinical (anthropometric) and laboratory baseline metabolic screening and monitoring of all patients initiating thymidine nucleoside –based regimen are needed.