Predicted Coronary Heart Disease Risk in Croatian HIV Infected Patients Treated with Combination Antiretroviral Therapy

We assessed the coronary heart disease (CHD) risk in 130 HIV-infected patients with no major past cardiovascular event treated with combination antiretroviral therapy (CART) between May 2004 and June 2005. We also investigated the association of HIV disease parameters (CD4+ T-cell counts, HIV viral load, AIDS diagnosis, antiretroviral medications and lipodystrophy), demographics, anthropometrics, clinical features, smoking status, dyslipidemia, adherence to the Mediterranean diet, and the metabolic syndrome (MS) to the Framingham risk score. The median 10-year CHD risk was 6.4% (IQR 3.3–13.0) for males and 1.8% (IQR 1.0–6.7) for females. The CHD risk was ³10% in 31.1% (32 of 103) males and in 14.8% (4 of 27) females. MS was present in 27 (20.8%) individuals. Participants who met the definition of the MS had a 2.63 times greater chance of having a CHD risk ³10% (95% CI, 1.09–6.39; p=0.032). On multivariable analysis, we found that a CHD risk ³10% was associated with: a lowest ever CD4+ T-cell counts of less than 50 per microliter and a past history of AIDS (OR, 6.26; 95% CI, 1.61–24.36; p=0.008); alcohol consumption ³10 g/day (OR, 3.87; 95% CI, 1.56–14.22; p=0.041); and age ³43 years (OR, 1.30; 95% CI, 1.17–1.45; p<0.001). Interventions to reduce the modifiable cardiovascular risk are needed in Croatian patients treated with CART

Predicted Coronary Heart Disease Risk in Croatian HIV Infected Patients Treated with Combination Antiretroviral Therapy

We assessed the coronary heart disease (CHD) risk in 130 HIV-infected patients with no major past cardiovascular event treated with combination antiretroviral therapy (CART) between May 2004 and June 2005. We also investigated the association of HIV disease parameters (CD4+ T-cell counts, HIV viral load, AIDS diagnosis, antiretroviral medications and lipodystrophy), demographics, anthropometrics, clinical features, smoking status, dyslipidemia, adherence to the Mediterranean diet, and the metabolic syndrome (MS) to the Framingham risk score. The median 10-year CHD risk was 6.4% (IQR 3.3–13.0) for males and 1.8% (IQR 1.0–6.7) for females. The CHD risk was ³10% in 31.1% (32 of 103) males and in 14.8% (4 of 27) females. MS was present in 27 (20.8%) individuals. Participants who met the definition of the MS had a 2.63 times greater chance of having a CHD risk ³10% (95% CI, 1.09–6.39; p=0.032). On multivariable analysis, we found that a CHD risk ³10% was associated with: a lowest ever CD4+ T-cell counts of less than 50 per microliter and a past history of AIDS (OR, 6.26; 95% CI, 1.61–24.36; p=0.008); alcohol consumption ³10 g/day (OR, 3.87; 95% CI, 1.56–14.22; p=0.041); and age ³43 years (OR, 1.30; 95% CI, 1.17–1.45; p<0.001). Interventions to reduce the modifiable cardiovascular risk are needed in Croatian patients treated with CART

Dyslipidemia and Adherence to the Mediterranean Diet in Croatian HIV-Infected Patients during the First Year of Highly Active Antiretroviral Therapy

We investigated the association of adherence to the Mediterranean diet and other risk factors for dyslipidemia in HIV-infected Croatian patients during the first year of highly active antiretroviral therapy (HAART). Adherence to the Mediterranean diet was determined by a 150-item questionnaire; a 0 to 9-point diet scale was created that stratified respondents as having low adherence (<4 points) and moderate to high adherence (ł 4 points). We interviewed 117 participants between May 2004 and June 2005 and abstracted their serum lipid measurements taken during the first year of HAART. The values of total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides increased most prominently in the first 3 to 6 months after initiation of HAART (average increase at 3 months: 25% for total cholesterol, 22% for LDL-cholesterol, 18% for HDL-cholesterol and 43% for triglycerides). A Mediterranean diet and physical activity had no effect on serum lipids. The mean total cholesterol was higher in participants receiving a combination of a non-nucleoside reverse transcriptase inhibitor and a protease inhibitor compared to participants receiving a combination of nucleoside analogs with a non-nucleoside analog or a combination of nucleoside analogs and a protease inhibitor. Among individual drug treatments, indinavir/ritonavir had the most unfavorable lipid profile. We conclude that adherence to a Mediterranean diet does not influence serum lipid profiles during the first year of HAART

Predicted coronary heart disease risk in croatian HIV infected patients treated with combination antiretroviral therapy [Predviđanje rizika koronarne bolesti srca u sudionika zaraženih HIV-om iz Hrvatske liječenih CART-om]

We assessed the coronary heart disease (CHD) risk in 130 HIV-infected patients with no major past cardiovascular event treated with combination antiretroviral therapy (CART) between May 2004 and June 2005. We also investigated the association of HIV disease parameters (CD4 + T-cell counts, HIV viral load, AIDS diagnosis, antiretroviral medications and lipodystrophy), demographics, anthropometrics, clinical features, smoking status, dyslipidemia, adherence to the Mediterranean diet, and the metabolic syndrome (MS) to the Framingham risk score. The median 10-year CHD risk was 6.4% (IQR 3.3-13.0) for males and 1.8% (IQR 1.0-6.7) for females. The CHD risk was > or = 10% in 31.1% (32 of 103) males and in 14.8% (4 of 27) females. MS was present in 27 (20.8%) individuals. Participants who met the definition of the MS had a 2.63 times greater chance of having a CHD risk 210% (95% CI, 1.09-6.39; p = 0.032). On multivariable analysis, we found that a CHD risk > or = 10% was associated with: a lowest ever CD4+ T-cell counts of less than 50 per microliter and a past history of AIDS (OR, 6.26; 95% CI, 1.61-24.36; p = 0.008); alcohol consumption 210 g/day (OR, 3.87; 95% CI, 1.56-14.22; p = 0.041); and age 243 years (OR, 1.30; 95% CI, 1.17-1.45; p < 0.001). Interventions to reduce the modifiable cardiovascular risk are needed in Croatian patients treated with CAR

Učestalost i rizični čimbenici lipodistrofije i dislipidemije u oboljelih od zaraze virusom humane imunodeficijencije liječenih vrlo djelotvornom kombinacijom antiretrovirusnih lijekova

Background: Lipoatrophy, lipohypertrophy and increased serum lipids are frequently observed during long-term highly active antiretroviral therapy (HAART) in persons with human immunodeficiency virus (HIV) infection. We investigated whether the consumption of a Mediterranean diet and physical activity are associated with lower risk of body shape changes and dyslipidemia in Croatian HIV-infected patients treated with HAART. The purpose of this study was to classify risk factors associated with these conditions. Methods: Between May 2004 and June 2005, we conducted a cross-sectional study of 136 adults with HIV-infection who were treated with HAART for at least one year. Lipoatrophy and lipohypertrophy were assessed by self-report and physical examination. Adherence to the Mediterranean diet was determined by a 150-item questionnaire; a 0 to 9-point diet scale was created that stratified respondents as having low adherence (<4 points) and medium to high adherence (≥ 4 points). Physical activity was assessed by an international physical activity questionnaire (IPAQ). Between July 1997 to May 2005 we prospectively collected demographic information and analyzed lipid levels in 117 participants infected with the human immunodeficiency virus at six time points during their first year of antiretroviral treatment. We used analysis of variance for repeated measurements for the analysis of the total cholesterol, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol, and triglycerides over time (procedure MIXED, SAS 9.1.3) Results: In our cross-sectional study we found that lipoatrophy was present in 56 (41%) and lipohypertrophy in 25 (32%) of patients infected with HIV. In multivariate analysis we found that non-smokers with a dietary score ≥ 4 had lower risk for lipoatrophy (OR 0,3 95% CI 0,1-0,8; p=0.021). Stavudine use (OR 3,9 95% CI 1,7-9,3; p=0.001), female gender (OR 0,3 95% CI 0,1-0,9; p=0.023), and duration of HAART for every twelve months (OR 1,5 95% CI 1,2 -1,9; p =0.001) were also independently associated with a higher risk of lipoatrophy. A medium to high adherence to the Mediterranean diet was associated with lower risk of lipohypertrophy (OR 0.3, 95% CI 0.1-0.8; p =0.010). Female gender (OR 11,1 95% CI 3,8-33,3; p=0.001), longer duration of HAART ≥ 25 months compared with those < 25 months (OR 6,2 95% CI 1,8-21,7; p=0.005), and longer known duration of HIV-infection prior to HAART (per 12 months) (OR 1,2 95% CI 1,1-1,3; p=0.004) were also independently associated with a higher risk of lipohypertrophy. Longitudinal study showed increased values of the total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides among participants infected with the human immunodeficiency virus after initiation of antiretroviral therapy. The increase was most expressed in the first 3 till 6 months of treatment (average increase at 3 months: 25% for total cholesterol, 22% for LDL-cholesterol, 18% for HDL-cholesterol and 43% for triglycerides). In the longitudinal study, neither adherence to the Mediterranean diet nor physical activity had an influence on lipid levels. The mean total cholesterol was higher in participants receiving a combination of a non-nucleoside reverse transcriptase inhibitor and a protease inhibitor (NNRTPI) (-10,5% CI -10,9-10,0%; p=0,007) compared to participants receiving a combination of a nucleoside analogs with a non-nucleoside analog (NRTNRTNNRT) or a combination of a nucleoside analogs and a protease inhibitor (NRTNRTPI) (-8,8% CI -10,0-7,5%; p=0,019). Participants receiving a combination of a nucleoside reverse transcriptase inhibitor and a protease inhibitor (NRTNRTPI) had higher triglyceride serum levels (-26,9% CI -36,1-20,4; p=0,012) than participants receiving a combination of nucleoside analogs with a non-nucleoside analog (NRTNRTNNRT). Among individual drug treatments, indinavir/ritonavir had the most unfavorable lipid profile. Other factors significantly associated with higher total cholesterol levels in serum were age older than 39 years (-9,2% CI -9,4-9,0%; p=0,028), heterosexual HIV transmission (-9,6% CI -13,0-6,7%; p=0,028), a baseline hemoglobin levels higher than 123 g/l (-10,2% CI -10,7-9,6%; p=0,002), smoking (-6,8% Cl -8,3-5,4%; p=0,041), and viral loads >400 copy/ml HIV RNK (5,1% CI 4,6-5,7%; p=0,012) were significantly associated with lower total cholesterol level. Baseline CD4 lymphocyte counts ≥ 50 mm3 were associated with higher HDL-cholesterol levels (-14,1% CI -16,8-11,8%; p=0,007) compared with participants with < 50 CD4 lymphocyte. Male gender (15,8% CI 12,0-19,0%; p=0,033) and participants who consumed ethanol ≥10 g/d had a lower of HDL-cholesterol level (18,2% CI 14,1-23,3%; p=0,017). Age older than 39 years (-13,0% CI -13,4-12,6%; p=0,024), baseline hemoglobin level higher than 123 g/l (-12,7% CI -13,1-12,1%; p=0,013) and smoking (-11,3% CI -14,5-8,7%; p=0,029) were associated with higher LDL-cholesterol level. Conclusions: HIV-infected persons from Croatia who did not smoke and who moderately or highly adhere to the Mediterranean diet are least likely to develop the clinical syndrome of lipoatrophy. Moderate to high adherence to the Mediterranean diet is also associated with a lower risk of lipohypertrophy. Mediterranean diet and physical activity appear to have no effect on serum lipids in persons on HAART. Antiretroviral therapy was the principal factor found to increase lipid levels, the treatment with a non-nucleoside reverse transcriptase inhibitor and a protease inhibitor had a higher effect on total cholesterol and triglyceride levels than combinations of nucleoside reverse transcriptase inhibitors with a non-nucleoside reverse transcriptase inhibitor or a protease inhibitor. Keywords: HIV-infection, HAART, lipoatrophy, lipohypertrophy, Mediterranean diet, physical activity, lipids, smoking

Predviđanje rizika koronarne bolesti srca u sudionika zaraženih HIV-om iz Hrvatske liječenih CART-om

We assessed the coronary heart disease (CHD) risk in 130 HIV-infected patients with no major past cardiovascular event treated with combination antiretroviral therapy (CART) between May 2004 and June 2005. We also investigated the association of HIV disease parameters (CD4 + T-cell counts, HIV viral load, AIDS diagnosis, antiretroviral medications and lipodystrophy), demographics, anthropometrics, clinical features, smoking status, dyslipidemia, adherence to the Mediterranean diet, and the metabolic syndrome (MS) to the Framingham risk score. The median 10-year CHD risk was 6.4% (IQR 3.3-13.0) for males and 1.8% (IQR 1.0-6.7) for females. The CHD risk was > or = 10% in 31.1% (32 of 103) males and in 14.8% (4 of 27) females. MS was present in 27 (20.8%) individuals. Participants who met the definition of the MS had a 2.63 times greater chance of having a CHD risk 210% (95% CI, 1.09-6.39; p = 0.032). On multivariable analysis, we found that a CHD risk > or = 10% was associated with: a lowest ever CD4+ T-cell counts of less than 50 per microliter and a past history of AIDS (OR, 6.26; 95% CI, 1.61-24.36; p = 0.008); alcohol consumption 210 g/day (OR, 3.87; 95% CI, 1.56-14.22; p = 0.041); and age 243 years (OR, 1.30; 95% CI, 1.17-1.45; p < 0.001). Interventions to reduce the modifiable cardiovascular risk are needed in Croatian patients treated with CARTProcijenili smo rizik koronarne bolesti (KB) u 130 sudionika zaraženih HIV-om, liječenih kombinacijom antiretrovirusnih lijekova (CART) koji nisu ranije imali veća kardiovaskularna oštećenja od svibnja 2004 do lipnja 2005. Također smo istražili povezanosti parametara HIV bolesti (broj CD4+ T stanica, stupanj HIV-viremije, AIDS dijagnoza, antiretrovirusni lijekovi, lipodistrofija) demografske, antropometrijske, kliničke odlike, pušački status, dislipidemiju, pridržavanje mediteranskoj prehrani i metabolički sindrom (MS) u odnosu na računanje Framingham-ovog rizika. Medijan desetgodišnjeg rizika KB je 6,4% (IQR 3,3–13,0) za muške i 1,8% (IQR 1,0–6,7) za ženske. Rizik od KB > ili = 10% je 31,1% (32 od 103) u muških i 14,8% (4 od 27) u ženskih. MS je bio prisutan u 27 (20,8%) pojedinaca. Sudionici sa MS imali su 2,63 puta veću šansu imati rizik KB > ili = 10% (95% CI 1,09–6,39; p=0,032). U multivarijatnoj analizi našli smo da će ispitanici imati rizik KB > ili = 10%: ako su ikad imali broj CD4+ T-stanica manje od 50 po mikrolitru i AIDS definirajuću bolest u anamnezi (OR 6,26; 95% CI 1,61–24,36; p=0.008); konzumirali alkohol > ili = 10 g/dnevno (OR, 3,87; 95% CI 1,56–14,22; p=0,041); i bili u dobi > ili = 43 godine (OR, 1,30; 95% CI 1,17–1,45; p<0,001). Potrebne su intervencije koje smanjuju promjenjive kardiovaskularne rizike u hrvatskih bolesnika koji se liječe CART-om

Dyslipidemia and adherence to the Mediterranean diet in Croatian HIV-infected patients during the first year of highly active antiretroviral therapy [Dislipidemija i pridržavanje mediteranskoj prehrani u bolesnika iz Hrvatske za vrijeme prve godine liječenja vrlo djelotvornom antiretrovirusnom terapijom]

We investigated the association of adherence to the Mediterranean diet and other risk factors for dyslipidemia in HIV-infected Croatian patients during the first year of highly active antiretroviral therapy (HAART). Adherence to the Mediterranean diet was determined by a 150-item questionnaire; a 0 to 9-point diet scale was created that stratified respondents as having low adherence ( or = 4 points). We interviewed 117 participants between May 2004 and June 2005 and abstracted their serum lipid measurements taken during the first year of HAART The values of total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides increased most prominently in the first 3 to 6 months after initiation of HAART (average increase at 3 months: 25% for total cholesterol, 22% for LDL-cholesterol, 18% for HDL-cholesterol and 43% for triglycerides). A Mediterranean diet and physical activity had no effect on serum lipids. The mean total cholesterol was higher in participants receiving a combination of a non-nucleoside reverse transcriptase inhibitor and a protease inhibitor compared to participants receiving a combination of nucleoside analogs with a non-nucleoside analog or a combination of nucleoside analogs and a protease inhibitor Among individual drug treatments, indinavir/ritonavir had the most unfavorable lipid profile. We conclude that adherence to a Mediterranean diet does not influence serum lipid profiles during the first year of HAART

Adherence to the Mediterranean diet is associated with a lower risk of body-shape changes in Croatian patients treated with combination antiretroviral therapy

Lipoatrophy and lipohypertrophy have been observed during long-term combination antiretroviral therapy (CART). We investigated whether consumption of a Mediterranean diet is associated with lower risk of body-shape changes in Croatian patients treated with CART. Between May 2004 and June 2005, we conducted a cross-sectional study of 136 adults with HIV-1 infection who were treated with CART for at least 1 year. Lipoatrophy and lipohypertrophy were assessed by self-report and physical examination. Adherence to a Mediterranean diet was determined by a 150-item questionnaire; a 0–9 point diet scale was created that stratified respondents as having low adherence (&lt;4 points) and moderate to high adherence (≥4 points). Lipoatrophy was present in 41% and lipohypertrophy in 32% of participants. Non-smokers with a dietary score ≥4 had the lowest risk for lipoatrophy. Stavudine use, female gender, and duration of CART were also independently associated with a higher risk of lipoatrophy. A dietary score of ≥4 was associated with lower risk of lipohypertrophy (adjusted OR 0.3, 95% CI 0.1–0.7; P = 0.012). Female gender, longer duration of CART, and longer known duration of HIV infection prior to CART were also independently associated with higher risk of lipohypertrophy. In conclusion, Croatians who did not smoke and moderately or highly adhered to the Mediterranean diet were least likely to have the clinical syndrome of lipoatrophy. Moderate to high adherence to a Mediterranean diet was associated with a lower risk of lipohypertrophy