Background: Antiretroviral therapy (ART) is associated with lipid abnormalities that
contribute to increased risk of cardiovascular (CV) events among patients with human immunodeficiency
virus (HIV)/acquired immunodeficiency syndrome (AIDS). Although disorders of lipid metabolism
associated with ART have been described before in developed countries, data on lipid profile
disorders associated with ART use in China are limited. This study aimed to examine the
changes in lipid profile among patients with HIV/AIDS who initiated lopinavir/ritonavir LPV/r or
efavirenz (EFV)-based antiretroviral treatment regimens, which continue to be widely used China
and other developing countries.
Methods: This is a retrospective, matched case-control study of HIV-positive patients initiating either
LPV/r or EFV regimens at the Beijing You’an Hospital, Capital Medical University between
July 2012 and January 2017. Generalized estimating equations were used to compare the differences
in total cholesterol [TC], triglycerides [TG], low-density lipoprotein-cholesterol [LDL-C], and highdensity
lipoprotein-cholesterol [HDL-C] at baseline and up to 24-months after ART initiation between
the two treatment arms.
Results: Baseline characteristics, including age, sex, CD4 cell count, viral load, and serum lipids,
which were comparable between the two groups. The LPV/r-based regimen group had increased
TC, TG, HDL-C, and LDL-C after 24-months of treatment. In the EFV-regimen group, TC, HDL-C,
and LDL-C were increased compared to baseline, while the TC/HDL-C ratio decreased, and TG did
not change significantly. After 24-months of treatment, the percentage of patients with dyslipidemia
in the LPV/r group was much higher than in the EFV group (84.0% vs. 52.6%, P<0.001), and
17(10%) patients on LPV/r-based regimens had severe dyslipidemia. Patients on LPV/r-based regimens
were at increased odds of hypercholesterolemia (odds ratio [OR]=1.709, P=0.038), hypertriglyceridemia
(OR=4.315, P<0.001), and high TC/HDL-C ratio (OR=1.951, P=0.003). However,
no significant difference was found in HDL-C (OR=1.246, P=0.186) or LDL-C (OR=1.253,
P=0.410) between the treatment groups.
Conclusion: Both LPV/r or EFV treatment regimens impacted patients’ lipid profiles. Compared to
EFV-based regimens, patients on LPV/r-based regimens had increased odds of dyslipidemia, such as
hypercholesterolemia, hypertriglyceridemia, or high TC/HDL-C ratio; however, there was no obvious
effect on LDL-C, which is more relevant to the development of the cardiovascular disease.