Metabolic changes in the patients on second-line highly active antiretroviral therapy (HAART): A prospective cohort study from north India

Introduction: In India, there is a genetic predisposition to insulin resistance and cardiovascular risk, the impact of ART (antiretroviral therapy) on lipid profile and blood sugar may be significant. The study of potential implications of highly active antiretroviral therapy (HAART)-associated metabolic syndrome is critical to prevent cardiovascular diseases in the Indian population. Aims: This study was done to determine the prevalence of metabolic changes (dyslipidaemia, hyperglycemia and insulin resistance) among HIV patients on second-line ART. Settings and Design: A prospective cohort study. Methods and Materials: We enrolled 150 patients, who were started on second-line HAART. Patients were investigated for fasting blood sugar, lipid profile and insulin level at baseline and after 6 months. Statistical Analysis: The data were analysed using SPSS software (version 20; IBM Corp., Armonk, N.Y., USA). Student's t-test was used to compare numerical variables in the two groups. P value < 0.05 was considered as statistically significant. Results: There was a significant increase in serum cholesterol, LDL and triglyceride in patients with protease inhibitors (PIs) containing regimens. LDL levels were increased from 65 to 80 mg/dL (P = < .003) after treatment. Triglycerides were increased from 138 to 152 mg/dL. (P = < 0.001). Median fasting blood sugar was increased from 85 to 96 mg/dL (P = < 0.002). HOMA-IR was also significantly increased in the PI group (1.54 vs. 2.1, P < .003). However, serum HDL did not change significantly. Conclusions: Appropriate drug selection with timely switching of ART is crucial to prevent metabolic complications in patients taking long-term PIs.