Impact of second-line antiretroviral regimens on lipid profiles in an African setting: the DART trial sub-study

Gomo, Zvenyika A. R., Hakim, James G., Walker, Sarah A., Tinago, Willard, Mandozana, Gibson, Kityo, Cissy, Munderi, Paula, Katabira, Elly, Reid, Andrew, Gibb, Diana M. and Gilks, Charles F. (2014) Impact of second-line antiretroviral regimens on lipid profiles in an African setting: the DART trial sub-study. AIDS Research and Therapy, 11 . doi:10.1186/1742-6405-11-32

Author Gomo, Zvenyika A. R.
Hakim, James G.
Walker, Sarah A.
Tinago, Willard
Mandozana, Gibson
Kityo, Cissy
Munderi, Paula
Katabira, Elly
Reid, Andrew
Gibb, Diana M.
Gilks, Charles F.
Title Impact of second-line antiretroviral regimens on lipid profiles in an African setting: the DART trial sub-study
Journal name AIDS Research and Therapy   Check publisher's open access policy
ISSN 1742-6405
Publication date 2014-10-02
Sub-type Article (original research)
DOI 10.1186/1742-6405-11-32
Open Access Status DOI
Volume 11
Total pages 8
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Formatted abstract
Increasing numbers of HIV-infected patients in sub-Saharan Africa are exposed to antiretroviral therapy (ART), but there are few data on lipid changes on first-line ART, and even fewer on second-line.


DART was a randomized trial comparing monitoring strategies in Ugandan/Zimbabwean adults initiating first-line ART and switching to second-line at clinical/immunological failure. We evaluated fasting lipid profiles at second-line initiation and ≥48 weeks subsequently in stored samples from Zimbabwean patients switching before 18 September 2006.


Of 91 patients switched to second-line ART, 65(73%) had fasting samples at switch and ≥48 weeks, 14(15%) died or were lost <48 weeks, 10(11%) interrupted ART for >14 days and 2(2%) had no samples available. 56/65(86%) received ZDV/d4T + 3TC + TDF first-line, 6(9%) ZDV/d4T + 3TC + NVP and 3(5%) ZDV + 3TC with TDF and NVP. Initial second-line regimens were LPV/r + NNRTI in 27(41%), LPV/r + NNRTI + ddI in 33(50%) and LPV/r + TDF + ddI/3TC/ZDV in 6(9%). At second-line initiation median (IQR) TC, LDL-C, HDL-C and TG (mmol/L) were 3.3(2.8-4.0), 1.7(1.3-2.2), 0.7(0.6-0.9) and 1.1(0.8-1.9) respectively. Levels were significantly increased 48 weeks later, by mean (SE) +2.0(0.1), +1.1(0.1), +0.5(0.05) and +0.4(0.2) respectively (p < 0.001; TG p = 0.01). 3% at switch vs 25% 48 weeks later had TC >5.2 mmol/L; 3% vs 25% LDL-C >3.4 mmol/L and 91% vs 41% HDL-C <1.1 mmol/L (p < 0.001). Similar proportions had TG >1.8 mmol/L (0 vs 3%) and TC/HDL-C ≥5 (40% vs 33%) (p > 0.15).


Modest lipid elevations were observed in African patients on predominantly LPV/r + NNRTI-based second-line regimens. Routine lipid monitoring during second-line ART regimens may not be warranted in this setting but individual cardiovascular risk assessment should guide practice.
Keyword Antiretroviral therapy
Lipid profile changes
Protease inhibitors
Non-nucleoside reverse transcriptase inhibitors
African setting
HIV-Infected patients
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes Article number 32

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Public Health Publications
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Citation counts: TR Web of Science Citation Count  Cited 1 times in Thomson Reuters Web of Science Article | Citations
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Created: Wed, 02 Mar 2016, 09:21:33 EST by Charles Gilks on behalf of Learning and Research Services (UQ Library)