EFFECT OF COMBINED ANTI-RETROVIRAL THERAPY ON FASTING BLOOD SUGAR, CHOLESTEROL AND TRIGLYCERIDES: A FIVE-YEAR PROSPECTIVE STUDY IN A TERTIARY CARE INSTITUTE OF HIMACHAL PRADESH (INDIA)
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Keywords
Combined Anti-Retroviral Therapy (cART), Fasting Blood Sugar, Cholesterol, and Triglycerides, Public Health
Abstract
The continuous rise in the number of individuals infected with Human Immunodeficiency Virus (HIV) each year remains a significant challenge to the survival of humanity. Patients infected with HIV who are undergoing implementation with cART experience adverse alterations in lipid and glucose metabolism, which coincide with the metabolic syndrome, resulting in a proatherogenic condition. "Antiretroviral medications could be influencing these metabolic changes. Adverse changes in glucose and lipid metabolism, lactic acidemia, bone dysfunctions, and unusual body fat distribution have been frequently observed as complications associated with HIV infection and potent antiretroviral therapy. 1
Aims and Objectives: This study seeks to evaluate the impact of cART on fasting blood sugar, serum cholesterol, and triglyceride levels. This is set against the aim of minimizing complications and halting the progression to AIDS, thereby enhancing the quality of life for individuals affected by HIV/AIDS in alignment with the UN Sustainable Development Goals.
Materials and Methods: A total of 315 HIV patients were examined over a period of five years. Various models were chosen based on parameters including Fasting Blood Sugar, Cholesterol, and Triglycerides. The impact of different covariates, including gender, age, and the patient's ongoing adherence to treatment, was assessed for each of the models fitted. The evaluation of our study spanned six months and unfolded over five years.
Findings: Individuals diagnosed with HIV/AIDS must adhere to Antiretroviral therapy for life to effectively reduce the viral load, given the chronic and debilitating nature of the disease. This report highlights the ongoing presence of lipid abnormalities after the initiation of cART and emphasizes the importance of ongoing monitoring for individuals infected with HIV as they are more prone to hypertension and diabetes mellitus as compared to HIV seronegative population.
References
2. Palella FJ Jr, Delaney KM, Moorman AC et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 1998;338:853-60.
3. Marins JR, Jamal LF, Chen SY et al. Dramatic improvement in survival among adult Brazilian AIDS patients. AIDS2003;17:1675-82.
4. Braitstein P, Brinkhof MW, Dabis F et al. Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries. Lancet 2006;367:817-24.
5. Fang CT, Chang YY, Hsu HM et al. Life expectancy of patients with newly diagnosed HIV infection in the era of highly active antiretroviral therapy. Q J Med 2007;100:97-105.
6. Lohse N, Hansen AB, Gerstoft J, Obel N. Improved survival in HIV-infected persons: consequences and perspectives. J Antimicrob Chemother 2007;60:461-3.
7. 7.Maagaard A, Kvale D. Mitochondrial toxicity in HIV-infected patients both off and on antiretroviral treatment: a continuum of distinct underlying mechanisms? J Antimicrob Chemother 2009;64:901-9. Epub 2009 Sep 9.
8. Carr A, Sâmaras K, Burton S et al. A syndrome of peripheral lipodystrophy, hyperlipidemia and insulin resistance in patients receiving HIV protease inhibitors. AIDS 1998;12:51-8.
9. Mattevi VS, Gasparotto AS, Lazzaretti RK et al. Apolipoprotein B gene polymorphisms are associated with higher cholesterol levels in HIV-infected individuals on HAART. Antiviral Therapy 2009; 14 (suppl 2): A52.
10. Côté HC. Mechanisms of antiretroviral therapy-induced mitochondrial dysfunction. Curr Opin HIV AIDS. 2007Jul;2(4):253-60.
11. Carr A, Cooper DA. Adverse effects of antiretroviral therapy.Lancet 2000; 356:1423–30.
12. 12.Rosenkranz SL, Yarasheski KE, Para MF, Reichman RC, Morse GD. Antiretroviral Drug Levels and Interactions Affect Lipid, Lipoprotein, and Glucose Metabolism in HIV-1 Seronegative Subjects: A Pharmacokinetic-Pharmacodynamic Analysis. Metab Syndr Relat Disord. 2007 Jun;5(2):163-73. doi: 10.1089/met 2006.0034. PMID: 18007962; PMCID: PMC2078603.
13. Schambelan, Morris*; Benson, Constance A.†; Carr, Andrew‡; Currier, Judith S.§; Dubé, Michael P.¶; Gerber, John G.∥; Grinspoon, Steven K.**; Grunfeld, Carl††; Kotler, Donald P.‡‡; Mulligan, Kathleen§§; Powderly, William G.¶¶; Saag, Michael S.***. Management of Metabolic Complications Associated With Antiretroviral Therapy for HIV-1 Infection: Recommendations of an International AIDS Society-USA Panel. JAIDS Journal of Acquired Immune Deficiency Syndromes 31(3): p. 257-275, November 1, 2002.
14. Safrin, Sharona,b; Grunfeld, Carla,c. Fat distribution and metabolic changes in patients with HIV infection. AIDS 13(18) p. 2493-2505, December 24, 1999.
15. Lo, Janeta; Abbara, Suhnyb; Shturman, Leonc; Soni, Anandc; Wei, Jeffreya; Rocha-Filho, Jose Ac; Nasir, Khurramc,d; Grinspoon, Steven Ka. Increased prevalence of subclinical coronary atherosclerosis detected by coronary computed tomography angiography in HIV-infected men. AIDS 24(2): p 243-253, January 2010. | DOI: 10.1097/QAD.0b013e328333ea9e
16. Riddler, Sharon A MD, MPH*; Li, Xiuhong MAS†; Otvos, James PhD‡; Post, Wendy MD, MS†; Palella, Frank MD§; Kingsley, Lawrence Dr.P.H*; Visscher, Barbara MD, Dr.P.H‖; Jacobson, Lisa P ScD†; Sharrett, A R MD, Dr.P.H.†. Antiretroviral Therapy is Associated With an Atherogenic Lipoprotein Phenotype Among HIV-1-Infected Men in the Multicenter AIDS Cohort Study. JAIDS Journal of Acquired Immune Deficiency Syndromes 48(3): p. 281-288, July 1, 2008. | DOI: 10.1097/QAI.0b013e31817bbbf0 6.
17. Brown TT, Cole SR, Li X et al. Antiretroviral therapy and the prevalence and incidence of diabetes mellitus in the Multicenter AIDS cohort study. Arch Intern Med 2005; 165: 1179–1184.
18. Seaberg E, Munoz A, Lu M et al. Association between highly active antiretroviral therapy and hypertension in a large cohort of men followed from 1984 to 2003. AIDS 2005; 19: 953–960.
19. Bergersen BM, Sandvik L, Bruun JN, Tonstad S. Elevated Framingham risk score in HIV-positive patients on highly active antiretroviral therapy: results from a Norwegian study of 721 subjects. Eur J Clin Micro Infect Dis 2004; 23: 625–630.
20. Berthold HK, Parhofer KG, Ritter MM et al. Influence of protease inhibitor therapy on lipoprotein metabolism. J Intern Med 1999; 246: 567–575.
21. Carr A, Samaras K, Thorisdottir A, Kaufmann GR, Chisholm DJ, Cooper DA. Diagnosis, prediction, and natural course of HIV-1 protease-inhibitor-associated lipodystrophy, hyperlipidaemia, and diabetes mellitus: a cohort study. Lancet 1999; 353: 2093–2099.
22. Dong KL, Gausserman LL, Flynn MM et al. Changes in body habitus and serum lipid abnormalities in HIV-positive women on highly active antiretroviral therapy (HAART). J Acquir Immune Defic Syndr 1999; 21: 107–113.
23. Allain CC, Poon LS, Chan CSG, Richmond W, Fu PC. Enzymatic determination of total serum cholesterol. Clin Chem 1974; 20: 470–475.
24. Georgi JV, Cheng HL, Margolick JB et al. Quality control in the flow cytometric measurement of T-lymphocyte subsets: the Multicenter AIDS Cohort Study experience. Clin Immunol Immunopathol 1990; 55: 173–186.
25. Effectiveness of Combined Anti-Retroviral Therapy [cART] on Viral Load and CD4 Count, in Reducing Progression to AIDS, in Improving the Quality of Life of Patients of HIV/AIDS in the Context of the U.N. Sustainable Development Goals (SDGs). A 5-Year Prospective Study in Himachal Pradesh (India). P. Katoch, Anup Kumar. Applied sciences research periodicals. Vol1No.8(2023)
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Dr. Pankaj Katoch
Assistant Professor Department of Microbiology Dr.RKGMC Hamirpur (H.P) India.
Dr. Anup Kumar
Assistant Professor Department of Pharmacology Dr.RKGMC Hamirpur (H.P) India.