Background: Increasing numbers of HIV-infected patients in sub-Saharan Africa are exposed to antiretroviral\ntherapy (ART), but there are few data on lipid changes on first-line ART, and even fewer on second-line.\nMethods: DART was a randomized trial comparing monitoring strategies in Ugandan/Zimbabwean adults initiating\nfirst-line ART and switching to second-line at clinical/immunological failure. We evaluated fasting lipid profiles at\nsecond-line initiation and ?48 weeks subsequently in stored samples from Zimbabwean patients switching before\n18 September 2006.\nResults: Of 91 patients switched to second-line ART, 65(73%) had fasting samples at switch and ?48 weeks, 14(15%)\ndied or were lost <48 weeks, 10(11%) interrupted ART for >14 days and 2(2%) had no samples available. 56/65(86%)\nreceived ZDV/d4T + 3TC + TDF first-line, 6(9%) ZDV/d4T + 3TC + NVP and 3(5%) ZDV + 3TC with TDF and NVP.\nInitial second-line regimens were LPV/r + NNRTI in 27(41%), LPV/r + NNRTI + ddI in 33(50%) and LPV/r + TDF + ddI/\n3TC/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),\n1.7(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\nmean (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%\n48 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).\nSimilar proportions had TG >1.8 mmol/L (0 vs 3%) and TC/HDL-C ?5 (40% vs 33%) (p > 0.15).\nConclusion: Modest lipid elevations were observed in African patients on predominantly LPV/r + NNRTI-based\nsecond-line regimens. Routine lipid monitoring during second-line ART regimens may not be warranted in this\nsetting but individual cardiovascular risk assessment should guide practice.
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