Prevalence and Correlates of Dyslipidemia among HIV-1 Infected and HIV-1 Uninfected Individuals in Nairobi, Kenya.

Abstract

<bold>Background</bold>: The burden of cardiovascular disease (CVD) in Sub-Saharan Africa is rising in the background of high prevalence of infectious diseases including HIV. Being HIV infected is associated with lipid imbalance (dyslipidemia), a risk factor for CVD. Whereas the use of certain antiretroviral treatment (ART) drugs has been shown to cause dyslipidemia, little is known about the burden of dyslipidemia in the absence of ART in Sub-Saharan Africa and the factors associated with dyslipidemia, particularly the amount of circulating HIV virus (viral load). <bold>Methods</bold>: In the parent study, HIV infected individuals who were not on ART and their HIV-uninfected partners were enrolled for a cohort study. At baseline, socio-demographic data and a detailed medical history were obtained and clinical physical examination performed on participants. Whole blood samples were collected, fractionated and stored frozen at -800C. For this nested study, a random sample of the frozen serum samples were thawed and assayed for total cholesterol and high density lipoprotein cholesterol (HDL). The proportion of participants with dyslipidemia, characterized by high total cholesterol or low HDL was compared between HIV-infected and HIV-uninfected individuals. Correlates evaluated for association with dyslipidemia included age, gender, CD4 cell count, viral load, body mass index, blood pressure and smoking. <bold>Results</bold>: Samples from 196 individuals, collected between 2007 and 2008, were assayed. Median age was 32 years (Interquartile range [IQR] 23-41 years). Of the 99 who were HIV-infected, 47 (47%) were male while 52 (52%) were female and median CD4 count was 393 cells/L (IQR 57-729). The proportion of individuals with dyslipidemia was high in both groups (>75%) though there was no significant difference between HIV-infected and HIV-uninfected individuals (p>0.05).Viral load was an independent risk factor associated with dyslipidemia (OR 6.1, p=0.028) <bold>Conclusion</bold>: Although there was no significant difference in prevalence of dyslipidemia comparing HIV- infected and HIV-uninfected individuals, the proportion of individuals with dyslipidemia was high irrespective of HIV infection status. Among the HIV-infected, high viral load was associated with increased risk of dyslipidemia. This would be important to consider when choosing the drug regimen during ART initiation.