Low HDL-cholesterol among HIV-1 infected and HIV-1 uninfected individuals in Nairobi, Kenya

Background: Antiretroviral treatment (ART) is associated with dyslipidemia yet little is known about the burden of dyslipidemia in the absence of ART in sub-Saharan Africa. We compared the prevalence and risk factors for dyslipidemia among HIV-infected ART-naive adults and their uninfected partners in Nairobi, Kenya. Methods: Non-fasting total cholesterol (TC) and high density lipoprotein cholesterol (HDL) levels were measured by standard lipid spectrophotometry on thawed plasma samples obtained from HIV-infected participants and their uninfected partners. Dyslipidemia, defined by high TC (> 200 mg/dl) or low HDL (< 40 mg/dl) was compared between HIV-infected and uninfected men and women. Results: Among 196 participants, median age was 32 years [ IQR: 23-41]. Median CD4 count among the HIV-infected was 393 cells/mu l (IQR: 57-729) and 90% had a viral load > 1000 copies/ml. Mean TC and HDL were comparable for HIV-infected and uninfected participants. Prevalence of dyslipidemia was 83.8% vs 78.4% (p = 0.27). Among the HIV-infected, those with a viral load > 1000 copies/ml were 1.5-fold more likely to have dyslipidemia compared to those with <= 1000 copies/ml (adjusted prevalence ratio [aPR] 1.5, 95% CI: 1.22-30.99, p = 0.02). BMI, age, gender, blood pressure and smoking were not significantly associated with dyslipidemia. Conclusions: Among ART-naive HIV-infected adults, high viral load and low CD4 cell count were independent predictors of dyslipidemia, underscoring the importance of early initiation of ART for viral suppression.