|Year : 2014 | Volume
| Issue : 1 | Page : 31-35
Lipid profile of HIV/AIDS patients attending antiretroviral clinic in Zaria, North-Western Nigeria
Rasheed Yusuf1, Aliyu Ibrahim Sambo1, Muktar Haruna Mohammed2, Hassan Abdulaziz2
1 Department of Chemical Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
2 Department of Haematology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
|Date of Submission||05-Aug-2013|
|Date of Acceptance||23-Sep-2013|
|Date of Web Publication||24-Mar-2014|
Department of Chemical Pathology, Ahmadu Bello University Teaching Hospital, Zaria
Introduction: Nigeria, the tenth most populous country in the world and the most populous country in sub-Saharan Africa, has the second highest population of people living with HIV, after South Africa. A variety of endocrinologic, metabolic and nutritional disturbances are common during the course of HIV infection. Most HIV/AIDS patients develop multiple metabolic abnormalities including insulin resistance, lipodystrophy and dyslipidemia leading to increased risk of cardiovascular disease (CVD). Objective: To assess the lipid profile of HIV/AIDS patients attending antiretroviral (ARV) clinic in Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria. Materials and Methods: Fifty HIV-seropositive patients on ARV therapy, 50 ARV-naοve HIV patients and also 50 HIV-negative controls were assessed for lipid profile status and CD4 count. BMI of all participants was calculated. Data obtained were analysed using SPSS 15.0. A P- value ≤ 0.05 was considered as statistically significant. Results: The mean values of lipid profile showed a significantly higher total cholesterol (P < 0.01) and HDL-cholesterol (P < 0.001) in HIV-positive patients on ARV therapy compared with ARV-naïve patients and controls. There was a positive significant correlation between CD4 count and total cholesterol as well as between CD4 count and LDL-cholesterol in patients on ARV therapy. A negative significant correlation was found between CD4 count and triglyceride in ARV-naïve patients. Atherogenic index was significantly lower (P < 0.01) in HIV-positive patients on ARV therapy. Conclusion: HIV infection leads to dyslipidemia which is probably worsened by ARV therapy; however, these dyslipidemia did not constitute CVD risk.
Keywords: Antiretroviral therapy, HIV, Lipid profile
|How to cite this article:|
Yusuf R, Sambo AI, Mohammed MH, Abdulaziz H. Lipid profile of HIV/AIDS patients attending antiretroviral clinic in Zaria, North-Western Nigeria. Sub-Saharan Afr J Med 2014;1:31-5
|How to cite this URL:|
Yusuf R, Sambo AI, Mohammed MH, Abdulaziz H. Lipid profile of HIV/AIDS patients attending antiretroviral clinic in Zaria, North-Western Nigeria. Sub-Saharan Afr J Med [serial online] 2014 [cited 2019 Mar 25];1:31-5. Available from: http://www.ssajm.org/text.asp?2014/1/1/31/129308
| Introduction|| |
Acquired Immune Deficiency Syndrome (AIDS) is caused by a retrovirus Human Immunodeficiency Virus (HIV). The virus attacks the immune system and leaves the body vulnerable to a variety of infections and cancers. 
HIV infection is a worldwide health problem that affects about 34 million men and women. Nigeria, the tenth most populous country in the world and the most populous country in sub-Saharan Africa, has the second highest population of people (about 3 million) living with HIV, after South Africa with about 5.6 million. 
A variety of endocrinologic, metabolic and nutritional disturbances are common during the course of HIV infection. Most HIV-infected patients develop multiple metabolic abnormalities including insulin resistance, lipodystrophy and dyslipidemia. 
Lipodystrophy and metabolic derangements associated with increased cardiovascular risk are observed frequently in HIV-infected patients who receive antiretroviral treatment (ART).  Additional factors that may influence atherogenesis and cardiovascular disease include AIDS-related infections. 
Anti-retroviral therapy (ART) using highly Active Anti-retroviral Therapy (HAART) has led to considerable reduction in morbidity and mortality associated with HIV infection. This has led to increased life expectancy in HIV-infected individuals on one hand, and increased side effects of chronic administration of these drugs on the other (such as dyslipidemia and lipodystrophy with increased risk of cardiovascular diseases). 
Also before the availability of HAART studies in HIV-infected individuals have shown a variety of lipid abnormalities.  Riddler et al., concluded in their study that HIV infection alone results in substantial decrease in total cholesterol, HDL-cholesterol and LDL-cholesterol with the post-treatment elevation in total cholesterol and LDL-cholesterol probably representing a return to pre-infection lipid level. 
Various studies conducted on lipid profile in HIV/AIDS patients in different countries show variation in results. ,,,,,
Although lipid metabolism in HIV-infected patients has been widely studied in many parts of the world, only few had been documented in Nigeria and none in our locality, therefore our study was to assess the lipid profile of HIV/AIDS patients in this environment.
| Materials and Methods|| |
This cross-sectional study was conducted between January, 2011 and March, 2011 among HIV-seropositive subjects aged 16-50 years attending ARV clinic in Ahmadu Bello University Teaching Hospital (ABUTH), Zaria in Northern Nigeria. The study was approved by the ethical committee of the hospital. Informed written consent was obtained from all participants.
One hundred and fifty participants were studied. They were grouped as follows; 50 HIV-seropositive subjects on ARV therapy, 50 patients who were ARV naïve confirmed with Western blot attending ARV clinic in ABUTH, Zaria (patients in both groups were randomly selected) and also 50 HIV-negative controls were assessed for lipid profile status. The subjects with features suggestive of diabetes mellitus, hypertension, renal disease and those with family history of dyslipidemia were excluded from the study to rule out other factor(s) that could affect or worsen lipid profile status.
Weight (kg) and height (m) of the studied subjects were recorded using a stadiometer with subjects wearing light clothing and without shoe. BMI was calculated as weight (kg)/Height (meter 2 ). About 10 ml of fasting venous blood sample was collected from each participant. From the sample collected 6 ml was dispensed into plain bottles and serum obtained from the clotted blood samples after centrifuging at 3000 rpm for 15 minutes and stored at 4 o C until assayed within 4 days after collection. Serum total cholesterol, triglyceride and HDL-cholesterol were assayed based on enzymatic methods using SELECTRA XL automated chemistry analyser with analysis in batches. Each assay was validated using commercial quality control samples, standards as well as previous assayed human sera. Samples were also duplicated in between batches. LDL-cholesterol was calculated from Friedwald΄s formula (LDL-cholesterol = Total cholesterol - (triglyceride/2.2) - HDL-cholesterol (mmol/L)).  Total cholesterol/HDL-cholesterol ratio (atherogenic index) was also calculated. The remaining 4 ml of blood was collected into EDTA containing bottles for CD4 count analysis using Cyflow meter (Partek).
Data obtained were analysed using SPSS 15.0 for window (Chicago, USA). The analysis of variance (ANOVA) and Student's t-test were used to compare mean values of variables. Also Pearson's linear correlation analysis to test significance of association was carried out. A P-value of less than or equal to 0.05 (P ≤ 0.05) was considered statistically significant.
| Results|| |
For the patients receiving ARV therapy, the mean duration on ARV drugs was 41.78 ± 3.98 months. The mean age of patients on ARV therapy, ARV naïve patients and controls were 37.40 ± 1.28, 36.84 ± 1.73 and 36.98 ± 0.99 years, respectively (P > 0.05). There was no statistically significant difference in BMI (P > 0.05) between patients on ARV therapy and controls but significantly higher than in ARV-naïve patients (P < 0.001) as shown in [Table 1].
|Table 1: Lipid profile, CD4 count and BMI (Mean ± SEM) in study population|
Click here to view
The mean values of lipid profile showed a significantly higher total cholesterol (P < 0.01) and HDL-cholesterol (P < 0.001) in HIV-positive patients on ARV therapy compared with ARV-naïve patients and controls, while HDL-cholesterol of ARV-naïve patients was significantly higher (P < 0.01) than in controls. The serum LDL-cholesterol was significantly lower (P < 0.05) in patients on ARV therapy and ARV-naive patients than in controls. There was no statistically significant difference in serum triglyceride (P > 0.05) between the study groups. Atherogenic index was significantly lower (P < 0.01) in HIV-positive patients on ARV therapy compared with that of ARV-naïve patients and controls [Table 1]. There were no statistically significant differences in the mean values of lipid profile in males and females in all the studied groups.
There was a statistically significant higher (P < 0.05) CD4 count in patients on ARV therapy than ARV-naive patients, while that of controls was significantly higher (P < 0.001) than that of both groups of patients [Table 1].
Hypocholesterolemia (serum cholesterol <2.5 mmol/L) was present in 20% and 2% of ARV-naïve patients and controls, respectively, while 29% of patients on ARV therapy and 6% controls had hypercholesterolemia (serum cholesterol >5.2 mmol/L).
There was a positive significant correlation between CD4 count and total cholesterol (r = 0.432, P = 0.002) as well as between CD4 count and LDL-cholesterol (r = 0.423, P = 0.002) in patients on ARV therapy [Figure 1] and [Figure 2], respectively]. A negative significant correlation was found between CD4 count and triglyceride (r = -0.430, P = 0.032) in ARV-naïve patients [Figure 3].
|Figure 1: Relationship between serum total cholesterol and CD4 count in patients on ARV therapy|
Click here to view
|Figure 2: Relationship between serum LDL-cholesterol and CD4 count in patients on ARV therapy|
Click here to view
|Figure 3: Relationship between serum triglyceride and CD4 count in ARV-naive patients|
Click here to view
A positive statistically significant association was observed between total cholesterol and BMI in ARV naïve patients (r = 0.526, P = 0.007) and controls (r = 0.284, P = 0.045) [Figure 4] and [Figure 5], respectively].
|Figure 4: Relationship between serum total cholesterol and BMI in ARV-naive patients|
Click here to view
|Figure 5: Relationship between serum total cholesterol and BMI in controls|
Click here to view
| Discussion|| |
Factors that may influence atherogenesis and cardiovascular disease in HIV-infected patients include AIDS related infection and dyslipidemia as a result of treatment using Highly Active Antiretroviral Therapy (HAART).
The significantly higher mean serum total cholesterol and HDL-cholesterol observed in the HIV/AIDS patients on antiretroviral therapy (ARV) compared with ARV naïve patients and controls in this study is in agreement with the findings of Khiangte et al., in a study based on evaluation of lipid profile in HIV/AIDS patients with and without HAART therapy and that of Young et al., on HIV/AIDS patients subjected to antiretroviral therapies comparing their efficacies and advantages.
The present study also showed no significance difference in the mean value of serum triglyceride in all the study groups but a significantly higher LDL-cholesterol in controls. This is in contrast to report by Obirikorang et al., which showed a significant increase in serum triglyceride among ARV naïve patients compared to controls, but the finding of significant decrease in LDL-cholesterol by the same study is in agreement with our observation. Arun et al., also reported a significantly higher level in serum triglyceride and LDL-cholesterol in ARV therapy naïve patients compared to controls.
Further study by Adewole et al., on the effect of antiretroviral therapy on lipid profile in HIV patients in Abuja, Nigeria, observed significantly higher levels of LDL-cholesterol and lower HDL-cholesterol in patients compared to controls. The observations made in this study did not conform to our study as we observed significantly lower LDL-cholesterol and higher HDL-cholesterol in patients compared to controls.
In another study conducted by Francis et al., on effect of highly active anti-retroviral therapy on lipid profile in HIV infected patients in Asaba, Nigeria, serum total cholesterol, LDL-cholesterol and triglyceride showed a significant increase in patients on HAART therapy compared to ARV naïve patients and controls, while in the present study only serum total cholesterol and HDL-cholesterol showed a significant increase in patients on ARV therapy.
The higher serum triglyceride and LDL-cholesterol observed among controls compared to patients in our study may be due to better nutritional status in controls.
Atherogenic index was within the normal reference value in all the studied groups but was significantly lower in HIV/AIDS patients on ARV therapy and thus had a lower risk of CVD compared with ARV-naive patients and controls. There was no significant difference in atherogenic index observed between ARV naïve patients and controls; this is agreement with finding of Arun et al., in their study of assessment of lipid profile in patients with human immunodeficiency virus (HIV/AIDS) without antiretroviral therapy.
The present study found a significantly higher CD4 count value in controls compared with patients on ARV therapy and those not on therapy, but higher in patients on ARV therapy compared with ARV therapy naïve patients. This is similar to findings of Oduola et al., Pasupathi et al., and Shacker.  Lower CD4 count in patients is likely due to invasion and destruction of CD4 T-cells by the human immunodeficiency virus (HIV) and improvement in the count with patients on therapy.
A significant positive correlation was found between total cholesterol and CD4 count and also between LDL-cholesterol level and CD4 count in patients on ARV therapy. This is instructive in that as the CD4 count improves with ARV therapy, there is corresponding increase in total cholesterol and LDL-cholesterol. This could be attributed to lipodystrophic (fat accumulation and fat atrophy) effects of some antiretroviral drugs (especially protease inhibitors) included in the HAART combination these patients are taking. 
A significant negative association was found between triglyceride and CD4 count of ARV therapy naïve patients. This showed that as CD4 count continues to drop, there will be a corresponding increase in serum triglyceride levels. This in agreement with finding by Iffen et al.  This may be due to release of stored triglyceride synthesized by the liver and adipose tissue in cases of starvation which is commonly found in HIV-infected patients as a result of reduced intake.
In the present study, a significant positive correlation was found between serum total cholesterol and BMI in both ARV therapy naïve patients and controls. It therefore follows that as the serum total cholesterol increases; there will be corresponding increase in BMI.
| Conclusions|| |
The findings of the present study suggest that HIV disease itself may have effect on lipid metabolism and probably worsen by ARV therapy since dyslipidemia was observed in both HIV-infected patients on ARV therapy and ARV-naïve patients and this constituted no CVD risk as the values of atherogenic indexes were within the reference range. It could also be concluded that lipid profile may be a good index of disease progression in HIV-infected patients as a result of presence of association between CD4 count and total cholesterol, triglyceride and LDL-cholesterol.
| References|| |
|1.||Khiangte L, Vidyabati RK, Singh MK, Devi SB, Singh TR, Singh WG. A study of serum Lipid Profile in Human Immunodeficiency Virus(HIV) infected patients. J Indian Acad Clin Med 2007;8:307-11. |
|2.||Aung San Suu Kyi, Michel Sidibe. UNAIDS World AIDS Day Report, 2012. |
|3.||Iffen TS, Efobi H, Usoro CAO and Udonwa NE. Lipid Profile of HIV-positive patients attending University of Calabar Teaching Hospital, Calabar-Nigeria. World J Med Sci 2010;5:89-93. |
|4.||Estrada V, Martinez-Larrad MT, Gonzalez-Sanchez JL, de Villar NG, Zabena C, Fernandez C, et al. Metabolic syndrome in HIV-infected patients. Metabolism 2006;55:940-5. |
|5.||Anderson JL. Infection, antibiotics and atherothrombosis-end of the road or new beginnings? N Engl J Med 2005;352:1706-1709. |
|6.||Jain RG, Furtine ES, Pedneault L, White AJ, Lenhard JM. Metabolic complications associated with anti-retroviral therapy. Antiviral Res 2001;51:151-77. |
|7.||Riddler SA, Smit E, Cole SR, Li R, Chmiel JS, Dobs A, et al. Impact of HIV infection on serum lipids in men. JAMA 2003;289:2978-882. |
|8.||Adewole OO, Eze S, Betiku Y, Anteyi E, Wada I, Ajuwon Z et al. Lipid profile in HIV/AIDS patients in Nigeria. Afr Health Sci 2010;10:144-9. |
|9.||Pynka ML, Bauder D, Pynka S, Boron-Kaizmarsk. HIV/AIDS Reviews 2004;2: 35-8. |
|10.||Crook M. The basis and management of metabolic abnormalities associated with cardiovascular risk in Human Immunodeficiency Virus infection and its treatment. Ann Clin Biochem 2007;44:219-31. |
|11.||Oduola T, Akinbolade AA, Oladokun LO, Adeosun OG, Bello IS, Ipadeola TI. Lipid profile in people living with HIV/AIDS on ARV therapy in urban area of Osun State, Nigeria. World J Med Sci 2009;4:18-21. |
|12.||Kumar A, Sathian B. Assessment of lipid profile in patients with human immunodeficiency virus (HIV/AIDS) without antiretroviral therapy. Asian Pac J Trop Dis 2011;1:24-7. |
|13.||Awah FM, Agughasi O. Effect of highly active anti-retroviral therapy (HAART) on lipid profile in human immunodeficiency virus (HIV) infected Nigerian population. Afr J Biochem Res 2011;5:282-6. |
|14.||Satya VR. Lipids and Lipoproteins. In: OA Afonja, editors. Chemical pathology and metabolic medicine teachers. 1 st ed. Surulere, Lagos: Miral Printing Press; 2011. p. 183-4. |
|15.||Young J, Weber R, Rickenbach M, Furrer H, Bernasconi E, Hirschel R, et al. Lipid profiles for antiretroviral-naive patients starting PI- and NNRTI- based therapy in the Swiss HIV cohort study. Antivir Ther 2005;10:585-91. |
|16.||Obirikorang C, Yeboah F, Quaye L. Serum lipid profiling in highly active antiretroviral therapy-naive HIV positive patients in Ghana; any potential risk? Webmedcentral 2010;1:WMC001558. |
|17.||Pasupathi P, Bakthavathsalam G, Saravanan G, Devaraj A. Changes in CD4 cell count, lipid profile and liver enzymes in HIV infection and AIDS patients. J Appl Biomed 2008;6:139-45. |
|18.||Schacker T, Collier AC, Hughes J, Shea T, Corey L. Clinical and Epidemiological features of primary HIV infection. Ann Intern Med 1996;125:257-64. |
|19.||Moro OS, Sidhartha P, Nilanjana M. HIV Nephropathy. Available from: http://www.emedicinehealth.com/specialties. [Last updated on 2007 Jan 30]. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]