ISSN 0331-8540

Nigerian Journal of Basic and Clinical Sciences • Volume 12 • Number 2 • July-December 2015 • Pages 67-???

Number 2 Volume 12 Year 2015

Nigerian Journal of
Basic and Clinical Sciences
Official Publication of Kano Medical Research Society
(College of Health Sciences, Bayero University and Aminu Kano Teaching Hospital, Kano)

www.njbcs.net
ORIGINAL ARTICLE Therapy‑related lipid profile changes
among patients’ on highly active
antiretroviral treatment in Kano,
North‑Western Nigeria
Idris Y. Mohammed, Isah A. Yahaya
Department of Chemical Pathology, Bayero University, Kano, Nigeria

ABSTRACT

Context: Highly active antiretroviral therapy (HAART), an effective treatment for human
immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) results in significant
reduction in viral load, increased CD4 cell count and improved quality of life of people living
with HIV/AIDS. HAART being a life‑long treatment increases the propensity for manifesting
long‑term complications like changes in lipid profile. Aims: This study set out to assess
therapy induced lipid profile changes among patients on HAART in Kano North‑Western
Nigeria. Design: Cross‑sectional. Settings: This study was conducted at the HIV clinic of the
Aminu Kano Teaching Hospital, Nigeria. Subjects and Methods: The study group consist of
120 patients on HAART (Group I) and 120 HAART naïve patients (Group II). Results: The
mean values of cholesterol, triglyceride (TG), low‑density lipoprotein cholesterol (LDLC) and
high‑density lipoprotein cholesterol (HDLC) were 4.15 mmol/L ± 1.03, 1.79 mmol/L ± 0.67,
2.79 mmol/L ± 0.98 and 0.99 mmol/L ± 0.28 in Group I, respectively and were statistically
significantly higher than 3.50 mmol/L ± 0.94, 1.21 mmol/L ± 0.55, 1.13 mmol/L ± 0.45 and 0.91
mmol/L ± 0.30 in Group II (P < 0.05). The prevalence of dyslipidaemia was high total cholesterol
in Group I (25%) Group II (7.5%): high TG in Group I (30%) > Group II (7.5%): High LDLC in
Group I (30%) > Group II (17.5%) low HDLC in Group II (40%) > Group I (35%). The prevalence
of hypertriglyceridemia was 43% in the protease inhibitor (PI) based and 16.7% in ’the non-PI
based groups respectively. Conclusions: This study confirms the existence of artherogenic lipid
profile in patients on HAART (especially those on PI‑based regimen) and further underscores
the importance of close monitoring to prevent cardiovascular complications.

Key Words: Dyslipidaemia, highly active antiretroviral therapy, human immunodeficiency virus/
acquired immune deficiency syndrome

INTRODUCTION in Sub‑Saharan Africa.[1] HIV/AIDS is

Access this article online
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DOI: 10.4103/0331-8540.169289
Quick Response Code:
The human immunodeficiency virus/
acquired immune deficiency syndrome
(HIV/AIDS) pandemic continues to spread
around the world at an alarming rate, and
the number of people with the disease
keep growing significantly, as it becomes
more geographically diffuse. There are
33.3 million people globally living with
HIV, out of which 22.5 million are living
a global crisis, a challenge to human life
and dignity with the ability to erode social
and economic development. It has great
influence on stability, life expectancy and
economic development.
This is an open access article distributed
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Address for correspondence:

Dr. Idris Y. Mohammed,
Department of Chemical Pathology, Bayero
University, Kano, Nigeria.
E‑mail: idrismoore@gmail.com
How to cite this article: Mohammed IY, Yahaya
IA. Therapy-related lipid profile changes among
patients’ on highly active antiretroviral treatment in
Kano, North-Western Nigeria. Niger J Basic Clin Sci
2015;12:111-5.

© 2015 Nigerian Journal of Basic and Clinical Sciences| Published by Wolters Kluwer - Medknow 111
 Mohammed and Yahaya: Lipid profile changes in patients’ on HAART
In Nigeria, estimates by the Federal Ministry of Health
Indicated that 2.98 million people were living with HIV/
AIDS in 2009 with a total AIDS death of 192, 000.[2] The
current prevalence rate is 4.1% with an estimated 3,458,363
people living with the virus and annual deaths of 217,121.[3]
Advances in the treatment of this infection with the advent
of highly active antiretroviral therapy (HAART) resulted in
significant reduction in HIV/AIDS morbidity and mortality.
These highly effective therapies come with several side effects
that are likely to increase as patients live longer. Changes
in serum lipids tending towards artherogenic profile is one
of such metabolic complications that may arise with the
use of HAART. Therapy‑induced dyslipidaemias seen is
characterised by increased low‑density lipoproteins (LDL)
and very LDL (VLDL). The constellation of dysmorphic
features described as lipodystrophy syndrome presents with
redistribution of body fat, peripheral lipoatrophy and central
fat accumulation. The pathogenesis of these metabolic
disturbances is not well understood and probably represents
a complex interaction between HIV infection itself, use of
antiretroviral therapy and the immune reconstitution effects
of treatment.
These metabolic abnormalities may harbour a significant
risk of developing cardiovascular disease. This fear is further
reinforced by many multicentre studies that documented
increased risk of arterial hypertension and myocardial
infarction following HAART use.[4‑6]
The metabolic complications are of major importance in
HIV therapy because they affect the quality of life of these
patients, and can potentially reduce treatment adherence.
With this new challenge in the management of HIV/
AIDS, this study was designed to evaluate dyslipidaemia
in HIV/AIDS patients on HAART so as to allow for proper
management of this complication as it arises.
SUBJECTS AND METHODS
This cross-sectional study was conducted on patients
(HAART-treated and HAART naïve) attending the adult
HIV clinic of the Aminu Kano Teaching Hospital (AKTH),
Nigeria. The study group (Group I) consisted of 120 patients
on HAART while 120 HAART naïve HIV‑positive patients
(Group II) were used as controls. Group I was further
sub‑grouped into those on the first line (Ia) and those on
second line (Ib) drugs.
Systematic sampling was used to select the study subjects
which included adults between the ages of 18 and 45 years.
112 Nigerian Journal of Basic and Clinical Sciences / Jul-Dec 2015 / Vol 12 | Number 2
Excluded from the study were patients with evidence of
pre-HAART dyslipidaemia, pregnancy, history of use of
drugs that aff ect lipids such as hypolipidaemic agents and
combined oral contraceptives, history of chronic disease
aff ecting the kidneys, liver or heart such as hypertension,
diabetes mellitus and cerebrovascular accidents, history of
smoking and/or alcohol use, history suggestive of thyroid
disorders, positive family history of lipid disorders, obesity,
co-infections with tuberculosis and hepatitis and severe
Undernutrition and wasting disease.
Patients were enrolled during a clinic visit and were required
to fast overnight after which blood samples were obtained
for serum lipid measurement.
Approval to carry out this study was obtained from the
Ethical Research Committee of AKTH. Written informed
consent was obtained from all subjects in the study, and the
provision of the Helsinki declaration was respected at every
step of the study.[7]
Laboratory methods
Concentrations of serum total cholesterol (TC), LDL
cholesterol (LDLC), high‑density lipoprotein cholesterol
(HDLC) and triglycerides (TGs) were measured using
enzymatic assays.
Triglycerides
TG was estimated by the enzymatic colorimetric method of
glycerol phosphate oxidase.[8]
High‑density lipoprotein cholesterol
Cholesterol in LDL, VLDL and chylomicron fractions was
precipitated by the action of a phosphotungstic acid in
the presence of magnesium ions. After centrifugation, the
cholesterol concentration in the remaining HDL fraction
which remains in the supernatant was determined by the
enzymatic colorimetric method.[9]
Total cholesterol
This was measured by the enzymatic colorimetric method.[10]
Low‑density lipoprotein cholesterol levels
This was calculated from TC, HDLC, and TG using the
Friedewald formula (for samples with TG < 5 mmol/L).[11]
Outcome measure
The National Cholesterol Education Program (NCEP)/Adult
Treatment Panel (ATP III) criteria were used.[12]
Quality control
Levels 1, 2 and 3 control samples were analysed with each
assay run and the batch samples whose controls values fell
 Mohammed and Yahaya: Lipid profile changes in patients’ on HAART

outside the established laboratory values (> ±2 standard Table 1: Serum levels (mean±SEM) of TC, triglycerides,
deviation [SD]) were repeated. LDL‑C, and HDL‑C
Category Total Triglyceride LDL HDL
Statistical analysis of results cholesterol cholesterol cholesterol
All data generated were collated, calculated and Group 1 4.15±1.03 1.79±0.67 2.79±0.98 0.99±0.28
Group 2 3.50±0.94 1.21±0.55 1.13±0.45 0.91±0.30
tabulated using Microsoft Excel spreadsheet (Microsoft.
LDL-C: Low-density lipoprotein cholesterol, HDL-C: High-density lipoprotein
(2007). Microsoft Excel (computer software). Redmond, cholesterol, TC: Total cholesterol
Washington: Microsoft). Mean values of age, body mass
index and serum lipids were calculated and tabulated.
Fisher’s exact test was used to determine the significance Table 2: Prevalence of dyslipidaemia
of differences in the prevalence of dyslipidaemia between Category Hightotal High High LDL Low HDL
cholesterol triglyceride cholesterol cholesterol
Groups I and II and within Group I. Analysis of variance (%) (%) (%) (%)
was used to compare the lipid parameters between and Group 1 25.0 30.0 30.0 35.0
within the study groups. Statistical significance was set at Group 2 7.5 7.5 17.5 40.0
95% confidence interval (P < 0.05). All data analysis were LDL-C: Low-density lipoprotein, HDL-C: High-density lipoprotein

performed with a statistical package (Graph Pad, Prism

3, version 6.04 for Windows, GraphPad Software, La Jolla
California, USA) and presented as a mean ± standard error
of mean and normality test P value.
RESULTS
The mean age of all the participants was 35.8 ± 8.5 years
while the corresponding mean age for Groups I and II were
33.46 ± 7.2 years, 34.52 ± 6.4 years respectively.
There was a slight female preponderance in all groups with
55.8% of Group I and 53.3% of Group II being females.
The mean ± SEM of lipid profiles of the controls and study
group are presented in Table 1. The level of serum TC,
TG, LDLC and HDLC were observed to be lower in the
HIV‑positive HAART naïve group than in patients on
HAART therapy.
The most frequent type of dyslipidaemia observed was
low HDLC, and this was most frequent in HIV‑positive
HAART naïve patients [Table 2]. High LDLC was more
prevalent in patients that were on HAART therapy. Both
hypertriglyceridaemia and hypercholesterolaemia appeared
to be more common in patients on HAART.
The prevalence of hypercholesterolaemia and
hypertriglyceridaemia were higher in patients on protease
inhibitor (PI) based regimen (36.7% and 43.3%) than in
patients on non-PI-based regimen (13.3% and 16.7%) as
shown in Table 3.
DISCUSSION
In this study, the mean age of the subjects with HIV
infection was 33.46 ± 7.2 and 34.52 ± 6.4 years for Groups I
Table 3: Prevalence of dyslipidaemia in Group I
Category Total Triglyceride LDL HDL
cholesterol cholesterol cholesterol
Group Ia 36.7 43.3 40.0 38.3
(PI treated)
Group Ib 13.3 16.7 20.0 31.7
(Non PI)
LDL-C: Low-density lipoprotein, HDL-C: High-density lipoprotein, PI: Protease
inhibitor
and II, respectively. The age group with the highest number
of subjects in both groups was between 30 and 34 years.
This suggests that HIV infection was highest among
young individuals in the area of study. Similarly, the sex
distribution showed a slight female preponderance in
HIV‑infected study groups with 55.8% of Group I and 53.3%
of Group II being females. This suggests that the disease is
more common in females than males. This finding is similar
to the international 2010 data from the centre for disease
control which showed highest prevalence of infection
in the age group between 25 and 34 years in the United
States.[13] A similar age and sex pattern of HIV infection
was reported in National figures of Nigeria (25–29 years).[1]
A study conducted in Cameroon to determine the effect
of HAART on serum lipids showed highest prevalence
among 31–49 years age group with a higher proportion of
women (68%) than men (32%).[14] Another study in South
Africa to determine the prevalence of HIV prevalence
found the highest prevalence to be among 20–24 years
age group and a significantly higher prevalence (15.5%) in
women than in men (4.8%).[14]
Dyslipidaemia in HIV infection has been related to elevated
cholesteryl ester transfer protein activity (high HDLC) and
decreased lipoprotein/hepatic TG lipase (high TGs). Studies
prior to the introduction of HAART have established a
decline in TC, LDLC and HDLC and a rise in TG among

Nigerian Journal of Basic and Clinical Sciences / Jul-Dec 2015 / Vol 12 | Number 2 113
 Mohammed and Yahaya: Lipid profile changes in patients’ on HAART
HIV‑infected individuals.[15,16] This decline occur more in
those with lower CD4, higher viral RNA load and longer
duration of treatment.[17‑21] In this study, a statistically
significant difference in the levels of serum lipids was
observed between the groups. The level of serum TC,
TG, LDLC and HDLC were observed to be lower in the
HIV‑positive HAART naïve group. This finding agrees
with previous reports of a high artherogenic profile in
HAART‑treated patients.[22,23]
Hypertriglyceridaemia was also found to be more
prevalent (30%) in HAART‑treated subjects than
hypercholesterolaemia (25%). The prevalence of
hypercholesterolaemia and hypertriglyceridaemia was
higher in patients on PI-based regimen (36.7% and 43.3%)
than in patients on non-PI-based regimen (13.3% and
16.7%) as shown in Table 3. This observed difference in
prevalence between the groups and between Group Ia and
Ib was shown to be statistically significant.
Several studies within and outside this country have
reported similar findings suggesting a higher levels and
prevalence of lipid disorders in patients on HAART.
Similarly, PI treatment was also observed to cause the
highest prevalence in such abnormalities. Other studies
linked the prolonged duration of treatment with higher
risk of dyslipidaemia.[22‑30]
CONCLUSION AND RECOMMENDATION
This study has established that dyslipidaemia is common
in both HIV positive HAART naïve and HAART‑treated
patients. While HIV infection is associated with significant
reduction in serum lipids prior to treatment, HAART is
associated with higher serum levels of TC, TG, LDLC and
HDLC. The prevalence of dyslipidaemia was higher in patients
on PI‑based HAART regimen, and they are more likely to
develop dyslipidaemia than those on a PI sparing regimen.
Based on the findings in this study, the following
recommendations are suggested
• All individuals that are HIV positive should undergo a
lipid profile test to detect and treat dyslipidaemia early
in the disease
• All HAART eligible patients should have a lipid profile
test done with a view to establishing a baseline
• Treatment regimen with the lowest risk of dyslipidaemia
should be offered to patients commencing treatment as
first‑line treatment option
• Treatment of patients with dyslipidaemia should be
guided by the levels of serum lipids, Co‑morbidities
114 Nigerian Journal of Basic and Clinical Sciences / Jul-Dec 2015 / Vol 12 | Number 2
and risk assessment according to the NCEP/ATP III
recommendations.[12]
Acknowledgement
The authors wish to thank the entire staff of
Professor S. S. Wali HIV Treatment Center and Professor
Christian Isichie for their support during data collection
and useful comments respectively.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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