MEDLINE Abstract: BACKGROUND:<BR>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.<BR>METHODS:<BR>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 â¥48 weeks subsequently in stored samples from Zimbabwean patients switching before 18 September 2006.<BR>RESULTS:<BR>Of 91 patients switched to second-line ART, 65(73%) had fasting samples at switch and â¥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/d4Tâ+â3TCâ+âTDF first-line, 6(9%) ZDV/d4Tâ+â3TCâ+âNVP and 3(5%) ZDVâ+â3TC with TDF and NVP. Initial second-line regimens were LPV/râ+âNNRTI in 27(41%), LPV/râ+âNNRTIâ+âddI in 33(50%) and LPV/râ+âTDFâ+âddI/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 (pâ<â0.001; TG pâ=â0.01). 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 (pâ<â0.001). Similar proportions had TG >1.8 mmol/L (0 vs 3%) and TC/HDL-C â¥5 (40% vs 33%) (pâ>â0.15).<BR>CONCLUSION:<BR>Modest lipid elevations were observed in African patients on predominantly LPV/râ+âNNRTI-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.<BR>
