Prevalence of dyslipidemia and dysglycemia in hiv-infected patients at the Kenyatta National Hospital
Manuthu, Evans M
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Background: Use of HAART in mv-infected individuals results in reduced morbidity and mortality associated with AIDS. Long-term complications associated withHAART including dysglycemia and dyslipidemia have however raised concern regarding accelerated cardiovascular disease risk in these patients. Objective: To determine the period prevalence of dyslipidemia and dysglycemia in HIV-infected patients attending the Kenyatta National Hospital. Design: A cross-sectional comparison study. Setting: Kenyatta National Hospital, a tertiary health care facility. Subjects: Consecutive HIV-Elisa positive patients consenting to participation who were not diabetic and not on lipid-lowering agents. Outcome: Dyslipidemia, defined as presence of any of the following lipid abnormalities: raised total or LDL cholesterol, low HDL cholesterol, or raised trigfycerides; and dysglycemia defined as presence of any of the following: impaired fasting glucose, impaired glucose tolerance, or diabetes mellitus. Results: Between January and April 2006, 342 patients were screened and 295 were recruited, 58% of whom were female. One hundred and thirty four (45%) were on HAART with 82% being on combinations of stavudine, lamivudine and either nevirapine or efavirenz. The overall prevalence of dyslipidemia was 63.1% while that of dysglycemia was 20.7%. High total cholesterol levels were found in 39.2% in patients receiving HAART against 10.0% in HAART naive patients (p<0.000I,OR- 5.18,CI 3.11-10.86). LDL cholesterol levels were raised in 40.8% in HAART patients and in 11.2% in patients not on HAART (p<0.0001R 5.43, CI2.973- 9.917).HDL levels were low in 14.6% and 51.3% among patients on HAART (p<0.000l, R 0.16, CI 0.091-0.29) and those not on HAART, respectively, while triglyceride levels were found to be elevated in 25.6% and 22.5% in HAART patients and HAART naive patients, respectively (p=0.5410R 1.184 CI0.688- 2.037).Among HAART patients compared to those not on HAART, diabetes was found in 1.5% against 1.2% (p=0.85), impaired fasting glucose in 2.2% against 0.6% (p=0.30) and impaired glucose tolerance in 16.4% against 21.1% (p=0.22), respectively. Conclusions: Patients infected with mv had a high prevalence of dyslipidemia and dysglycemia. Use of HAART was associated with high levels of total, and LDL cholesterol and high triglyceride levels, a lipid profile that could potentially increase the risk of cardiovascular disease. However, HAART was not associated with low HDL cholesterol and had no significant effect on the various categories of dysglycemia.