Perfil lipídico em individuos iniciando a terapia antirretroviral em uso de dolutegravir e efavirenz em Belo Horizonte, Minas Gerais.

Abstract

Prolonged use of antiretroviral therapy (ART) to treat human immunodeficiency virus (HIV) infection is associated with dyslipidemia and metabolic and cardiovascular complications. Options available to try to minimize the risk of cardiovascular disease (CVD) include antiretroviral drugs with less impact on the lipid profile. Advances in ART have provided significant improvement in the overall health and life expectancy of people living with HIV (PLHIV). With current therapy HIV-infected individuals show no evidence of increased risk of death compared to the general population. Few deaths have been directly related to HIV. The most common cause of death was CVD or sudden death, followed by non-AIDS-related malignancies. This study is a prospective cohort conducted in three public referral services for specialized HIV/AIDS care in Belo Horizonte, in which we aimed to prospectively assess and compare the lipid profile in people starting antiretroviral therapy using efavirenz or dolutegravir. The primary endpoint assessed was the presence of dyslipidemia demonstrated by changes in any of the serum levels of cholesterol fractions, changes in any fraction, or changes in the level of isolated fractions, of total cholesterol (TC), and/or high density lipoprotein (HDL-C), and/or low density lipoprotein (LDL-C), and/or very low density lipoprotein (VLDL-C), and/or triglycerides (TG), before and after initiation of ART. The presence of dyslipidemia was assessed within the 24-week period before and 72 weeks after antiretroviral dispensing. Statistical analyses were performed using R version 4.0.2 software and presented in the form of tables and graphs. In all tests, a p value < 0.05 was considered statistically significant. Among the 468 individuals followed-up in the three services, aged 18 years or older, 180 had their lipid profile measured and were included in this study. We observed a prevalence of dyslipidemia before and after ART, by any fraction, of 74.4% pre and 66.7% post; in relation to the TC was 13.3% and 20%, HDL-C 63.3% and 50.6%, LDL-C 10% and 12.2%; VLDL-C 12.8% and 26.7% and TG 27.2% and 26.7% respectively. For the comparisons of serum level of lipid profile by fractions, pre and post ART, a paired test was used, and all values showed an increase. For the serious HDL level pre ART the median was 37 mg/dL (IIQ = 31 - 42.3) and post ART 49 mg/dL (IIQ = 34 - 48) with p < 0.0001, the only one with statically significant change. When comparing the serum level of the lipid profile in the group that started the medication with EFZ and the group that started with DTG, in the first group there was an increase in the serum level of all fractions after the use of EFZ; for HDL the median pre-TARV was 37 mg/dL (IIQ = 32 - 43) and post-TARV 42 mg/dL (IIQ = 36 - 50) with p < 0.00001. In the DTG group, there was an increase in serum level only for VLDL-C; TC and TG showed no changes and for HDL-C a small decrease of 01 mg/dL was found. None of the changes in the DTG group were statically significant. In conclusion, in this study, neither the use of ART nor the use of EFZ compared with the use of DTG had a negative impact on the lipid profile. There was a positive impact on the lipid profile of the individuals who used EFZ since increased HDL can decrease the risk for cardiovascular disease (CVD). Despite the short observation time of the individuals and the mean age of 34 years, it was observed that in this profile of individuals, EFZ and DTG proved to be safe regarding the lipid profile for the treatment of PLHIV.