| Title: |
Changes in Cardiovascular Disease Risk Factors With Immediate Versus Deferred Antiretroviral Therapy Initiation Among HIV-Positive Participants in the START (Strategic Timing of Antiretroviral Treatment) Trial |
| Authors: |
Baker, JV; Sharma, S; Achhra, AC; Bernardino, JI; Bogner, JR; Duprez, D; Emery, S; Gazzard, B; Gordin, J; Grandits, G; Phillips, AN; Schwarze, S; Soliman, EZ; Spector, SA; Tambussi, G; Lundgren, J |
| Source: |
urn:ISSN:2047-9980 ; Journal of the American Heart Association, 6, 5, e004987 |
| Publisher Information: |
Wolters Kluwer |
| Publication Year: |
2017 |
| Collection: |
UNSW Sydney (The University of New South Wales): UNSWorks |
| Subject Terms: |
32 Biomedical and Clinical Sciences; 3202 Clinical Sciences; Heart Disease; Clinical Research; HIV/AIDS; Clinical Trials and Supportive Activities; Infectious Diseases; Hypertension; Cardiovascular; Atherosclerosis; Prevention; 6.1 Pharmaceuticals; Infection; 3 Good Health and Well Being; Adult; Anti-HIV Agents; Cardiovascular Diseases; Comorbidity; Cyclic N-Oxides; Drug Administration Schedule; Female; Follow-Up Studies; Global Health; HIV; HIV Infections; Humans; Male; Mercaptoethanol; Risk Assessment; Risk Factors |
| Description: |
Introduction-—HIV infection and certain antiretroviral therapy (ART) medications increase atherosclerotic cardiovascular disease risk, mediated, in part, through traditional cardiovascular disease risk factors. Methods and Results-—We studied cardiovascular disease risk factor changes in the START (Strategic Timing of Antiretroviral Treatment) trial, a randomized study of immediate versus deferred ART initiation among HIV-positive persons with CD4 + cell counts >500 cells/mm 3 . Mean change from baseline in risk factors and the incidence of comorbid conditions were compared between groups. The characteristics among 4685 HIV-positive START trial participants include a median age of 36 years, a CD4 cell count of 651 cells/mm 3 , an HIV viral load of 12 759 copies/mL, a current smoking status of 32%, a median systolic/diastolic blood pressure of 120/76 mm Hg, and median levels of total cholesterol of 168 mg/dL, low-density lipoprotein cholesterol of 102 mg/ dL, and high-density lipoprotein cholesterol of 41 mg/dL. Mean follow-up was 3.0 years. The immediate and deferred ART groups spent 94% and 28% of follow-up time taking ART, respectively. Compared with patients in the deferral group, patients in the immediate ART group had increased total cholesterol and low-density lipoprotein cholesterol and higher use of lipid-lowering therapy (1.2%; 95% CI, 0.1–2.2). Concurrent increases in high-density lipoprotein cholesterol with immediate ART resulted in a 0.1 lower total cholesterol to high-density lipoprotein cholesterol ratio (95% CI, 0.1–0.2). Immediate ART resulted in 2.3% less BP-lowering therapy use (95% CI, 0.9–3.6), but there were no differences in new-onset hypertension or diabetes mellitus. Conclusions-—Among HIV-positive persons with preserved immunity, immediate ART led to increases in total cholesterol and low-density lipoprotein cholesterol but also concurrent increases in high-density lipoprotein cholesterol and decreased use of blood pressure medications. These opposing effects suggest that, in the ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
unknown |
| Relation: |
http://purl.org/au-research/grants/nhmrc/APP1033140; http://purl.org/au-research/grants/nhmrc/APP1042313; http://purl.org/au-research/grants/nhmrc/APP1052979; https://hdl.handle.net/1959.4/unsworks_53419; https://doi.org/10.1161/JAHA.116.004987 |
| DOI: |
10.1161/JAHA.116.004987 |
| Availability: |
https://hdl.handle.net/1959.4/unsworks_53419; https://unsworks.unsw.edu.au/bitstreams/3fdef4d2-938a-405e-9cae-0e3c67b222ee/download; https://doi.org/10.1161/JAHA.116.004987 |
| Rights: |
open access ; https://purl.org/coar/access_right/c_abf2 ; CC BY-NC-ND ; https://creativecommons.org/licenses/by-nc-nd/4.0/ ; free_to_read |
| Accession Number: |
edsbas.7B136EBB |
| Database: |
BASE |