RESUMO
Background: Recently, dolutegravir-based therapy has become the first-line treatment when compared to others. However, dolutegravir-associated side effects in the liver and levels of efficacy haven't been addressed yet in underdeveloped countries such as Ethiopia. Objective: The purpose of this study was to compare liver function tests, CD4+ counts, and viral load among people living with HIV on dolutegravir and efavirenz-based antiretroviral regimens at Debre Markos Comprehensive Specialized Hospital in Northwest Ethiopia. Methods: An institutional-based comparative cross-sectional study was carried out from May 20 to July 10, 2020. An equal number of dolutegravir and efavirenz-prescribed patients (n = 53 each) for 6 months and above were included, and a judgmental sampling technique was used. A comparison of categorical and continuous parameters was analyzed with chi-square and an independent t-test, respectively, using SPSS version 26. A multivariable logistic regression was conducted and considered statistically significant at a p-value of <0.05. Results: The magnitude of liver enzyme (AST/ALT) abnormalities was 22.4 % (12/53) and 30.2 % (16/53) among dolutegravir- and efavirenz-prescribed patients, respectively. The dolutegravir group had significantly higher mean CD4+ counts than the efavirenz group (589.40 ± 244.38 vs. 450.64 ± 203.54 cell/mm3; p = 0.002). The efavirenz group had a significantly higher mean viral load than the dolutegravir group (783.83 ± 476.82 vs. 997.98 ± 439.11 cp/ml; p = 0.032). There was a statistically insignificant difference in AST (p = 0.709) or ALT (p = 0.687) between dolutegravir and efavirenz-based regimens. The multivariable logistic regression analysis revealed that BMI ≥25 kg/m2 was associated with liver enzyme abnormalities (AOR = 6.60, 95 % CI: 1.17, 42.82). Conclusion: A dolutegravir-based regimen was more likely to result in patients achieving higher efficacy for viral suppression and a CD4+ count increase. Although the differences were statistically insignificant, the mean AST and ALT levels were marginally higher in efavirenz-treated groups than in dolutegravir-treated groups.
RESUMO
Background: Highly active anti-retroviral therapy has been reported to be associated with a number of side effects in human immunodeficiency virus patients among which dyslipidemia isa common metabolic disorder. Methods: A Hospital based comparative cross-sectional study among 228 HIV positive patients was conducted from July to August 2020. Socio-demographic and clinical data were collected using structured questionnaires. Fasting venous blood sample was collected and analyzed for Lipid profiles. EDTA sample was analyzed for CD4+ T cell determination. Anthropometric measurement was done. Data were analyzed using SPSS version 22. Independent t-test was done. Logistic and binary regression was done. Result: A total of 228 HIV patients were enrolled in the study. Prevalence of dyslipidemia in HAART naive and HAART treated patients was 61 (53.5%) and 84 (73.7%), respectively. The prevalence of Total Cholesterol ≥200 mg/dl was 50% and 30%; High density lipoprotein cholesterol <40 mg/dl was 43.8% and 36%; Low density lipoprotein cholesterol ≥130 mg/dl was 48.3% and 28.1%; and Triglyceride ≥ 150 mg/dl 59.6% and 39% among HAART treated and HAART naive, respectively. Age greater than 40 years (AOR = 3.27, 95% C.I: 1.47-7.25), blood pressure ≥140/90 (AOR = 16.13, 95% C.I: 5.81-44.75), being on HAART (AOR = 2.73, 95% C.I: 1.35-5.53) and body mass index >25 kg/m2 (AOR = 1.92, 95% C.I: 1.20-4.81) were identified as determinants of dyslipidemia. Conclusion: The mean value of lipid profile was significantly higher among HAART treated as compared to those HAART naive HIV positive clients.
