Factor relation to Dyslipidemia Status of AIDs Patients Receiving an Antiretroviral Drugs in Phibonmunsahan Hospital Paratda Srisombat Pharmacist at Phibonmunsahan.

งานนำเสนอเรื่อง: "Factor relation to Dyslipidemia Status of AIDs Patients Receiving an Antiretroviral Drugs in Phibonmunsahan Hospital Paratda Srisombat Pharmacist at Phibonmunsahan."— ใบสำเนางานนำเสนอ:

1 Factor relation to Dyslipidemia Status of AIDs Patients Receiving an Antiretroviral Drugs in Phibonmunsahan Hospital Paratda Srisombat Pharmacist at Phibonmunsahan Hospital, Thailand

2 Introduction งานเภสัชกรรม ปฐมภูมิ Dyslipidemia is frequently observed in AIDs patients,This is a main Cardiovascular Disease. Last year showed statistics from Phibonmunsahan Hospital has increased Dyslipidemia Status of AIDs Patients Receiving an Antiretroviral Drugs that 16.93% to 21.16%. These patients prone to cardiovascular disease in the future.

3 Objective 1. To study the cumulative incidence of dyslipidemia 2. Evaluate factor relation to dyslipidemia status of patients using antiretroviral drug in Phibonmunsahan Hospital

4 GLOSSARY งานเภสัชกรรม ปฐมภูมิ 1. Dyslipidemia means  low density lipoprotein-cholesterol (LDL-C) > 160 mg/dl  high density lipoprotein cholesterol (HDL-C) < 40 mg/dl  triglyceride (TG) > 200 mg/dl

5 GLOSSARY งานเภสัชกรรม ปฐมภูมิ 2. AIDs Patients Receiving an Antiretroviral Drugs means o Self medication clinic o ARV medicines Continuously for at least six months o Age 20 and over o Can read and write o No hearing problems o Agreed to cooperate in research

6 Framework งานเภสัชกรรม ปฐมภูมิ gender, smoking, drinking alcohol Exercise, Antiretroviral Drugs Dyslipidemia Triglyceride (TG) > 200 mg/dl LDL > 160 mg/dl HDL <40 mg/dl Evaluate factor relation to dyslipidemia status

7 Methods งานเภสัชกรรม ปฐมภูมิ A cross-sectional descriptive study recording and tracking patients attending an outpatient HIV clinic in Phibonmunsahan Hospital, during March and April 2015. Patients assessed for cardiovascular risk by The Framingham Risk Score. We assessed independent associated factors for dyslipidemia using multiple logistic regressions.

8 Characteristics DataNumber=44 Number% Gender Male1840.91 Female2659.09 Age Mean±SD 44.11± 10.41 20-39 years1431.82 40-59 years2556.82 ≥60 years511.36 Education ≤ primary education3375.00 Secondary education920.45 College certificate12.27 ≥ Bachelor degree12.27 Results from 44 patients on ART were studied and results show that:majority of the studied population were female (59.09%) aged between 40-59 (56.82%) ; lower levels of education not exceeding primary education (75%)

9 Characteristics Data Number=44 Number% Underlying disease yes36.82 no4193.18 Drug allergy yes1111.00 no3375.00 drank alcohol never2556.82 been drinking511.36 drinking1431.82 Smoking Non-smokers3170.45 Been smoking818.18 Smoker511.36 Exercise Non exercise1329.55 regularly exercise3170.45 Results never drank alcohol (56.82%), regularly exercise (70.45%), non-smokers (70.45%).

10 AIDs Patients Receiving an Antiretroviral Drugs Antiretroviral DrugsNumber=44 Number% Zidovudine+lamivudive+Nervirapine21 47.73 Zidovudine+lamivudive + Efaverenze14 31.82 Tenofovir+lamivudive+ Efaverenze4 9.09 Tenofovir+lamivudive+Nervirapine1 2.27 Zidovudine +Tenofovir+Lopinavir/ritonavir4 9.09 Results from 44 patients on Antiretroviral Drugs show that:majority of Antiretroviral Drugs were Zidovudine+lamivudive+Nervirapine 47.73%

11 Characteristics

12 Dyslipidemia Status, in accordance with the NCEP ATP III criteria mg/dlNumber=44 Number% LDL-C Mean±SD 115.09±32.18 < 1001636.36 100-1291329.55 130-1591227.27 160-18936.82 > 19000.00 TG Mean±SD 166.75±84.08 <1502352.27 150–199920.45 200–4991227.27 ≥50000.00 Accordance with the NCEP ATP III criteria, found total cholesterol. (over 240 mg / dl.) 9.09% and triglyceride levels to be (200-499 mg / dl.) 27.27%

13 mg/dlNumber=44 Number% Total cholesterol Mean±SD185.70±40.75 < 2002761.36 200-2391329.55 > 24049.09 HDL-C Mean±SD 53.25±18.45 <401022.73 40-602556.82 > 60920.45 Dyslipidemia Status, in accordance with the NCEP ATP III criteria Accordance with the NCEP ATP III criteria, found total cholesterol. (over 240 mg / dl.) 9.09% and high-density lipoprotein cholesterol (below 40 mg /dl.) 22.73%

14 Framingham Risk Score 10 year risk Total Number= 44results Number% < 10 %3886.36level 1 Low Risk 10 – 20 %613.64level 2 Intermediate Risk > 20 %00.00level 3 High Risk assess cardiovascular risk by Framingham Risk Score found that 86.36 % were low-risk (level 1) and 13.64 % were intermediate Risk (level 2).

15 Factor relation is associated with LDL-C> 160 mg/dl FactorOR95%CIp-Value lowerUpper gender(male,female)1.4170.11916.910.782 smoking0.9030.8051.0140.245 Drank alcohol0.6390.0547.6170.721 Exercise0.8280.06810.0110.882 Zidovudine (No,Yes)1.0830.9891.1860.521 Lamivudine (No,Yes)1.0790.9901.1760.627 Tenofovir(No,Yes)0.9190.8351.0110.435 Nevirapine(No,Yes)2.1000.17625.0100.550 Efaverenz(No,Yes)0.6390.0547.6170.721 Lopinavir/r(No,Yes)0.9270.8501.0100.627 gender, smoking, drinking alcohol,exercise there and Antiretroviral Drugs was no association of Dyslipidemia Status.

16 Factor relation is associated with TG> 200 mg/dl FactorOR95%CIp-Value lowerUpper gender(male,female)0.9580.2493.6840.950 smoking3.5710.87414.6020.069 drinking alcohol0.9180.2403.5190.901 Exercise3.6670.40733.0240.222 Zidovudine (No,Yes)0.5170.0753.5570.497 Lamivudine (No,Yes)0.1610.0131.9730.112 Tenofovir(No,Yes)2.3330.43712.4540.313 Nevirapine(No,Yes)0.2280.0521.0070.042 Efaverenz(No,Yes)2.3330.6039.0231.544 Lopinavir/r(No,Yes)6.2000.50775.8380.112 Multiple logistic regression analysis has shown Nevirapine (OR = 0.228,95% CI = 0.052-1.007) is associated with high triglyceride levels was statistically significant (p-Value <0.05)

17 Factor relation is associated with HDL<40mg/dl FactorOR95%CIp-Value lowerUpper gender(male,female)0.6190.1502.5600.506 smoking1.0290.2204.8010.971 drinking alcohol0.8440.2013.5460.817 Exercise1.0370.1796.0180.968 Zidovudine (No,Yes)0.1460.0201.0430.035 Lamivudine (No,Yes)0.1210.0101.5090.060 Tenofovir(No,Yes)16.003.414 16.0570.001 Nevirapine(No,Yes)0.3380.0751.5350.150 Efaverenz(No,Yes)1.4290.3475.8820.620 Lopinavir/r(No,Yes)8.2500.66312.7060.060 Multiple logistic regression analysis has shown Zidovudine (OR = 0.146,95% CI = 0.020-. 1.043) with Tenofovir (OR = 16,95% CI = 3.414-16.057) is associated with low levels of, high-density lipoprotein cholesterol statistically significant (p-Value <0.05),

18 Conclusion งานเภสัชกรรม ปฐมภูมิ The data provided show high chance of dyslipidemia after initiation of ART. Long-term follow-up will help identify the impact of ART on cardiovascular risk. Dyslipidemia is highly common in Patients receiving antiretroviral drugs atPhibonmunsahan Hospital. Lifestyle modification, changing ARV and switchingto other ARV regimen can help reduce these abnormalities. Furthermore, suitable strategies and plans are necessary to prevent cardiovascular diseases in the future.

19 Restriction งานเภสัชกรรม ปฐมภูมิ Restrictions for this study include: small sample size and the use of other types of food samples. Time for antiretrovirals can not be inherited control in education. He predicts that factors relating to disorders of lipids are relatively low.

20 Bibliography งานเภสัชกรรม ปฐมภูมิ

21 Bibliography งานเภสัชกรรม ปฐมภูมิ

22 Other related research

23 Shows the distribution of lipids, glucose and FRS before and after ART. All means were significantly higher in the second measurement. Reference: Lauro Ferreira da Silva Pinto Neto, Mariza Barros das Neves, Rodrigo Ribeiro-Rodrigues, Kimberly Page, Angelica Espinosa Mirandab. Dyslipidemia and fasting glucose impairment among HIV patients three years after the first antiretroviral regimen in a Brazilian AIDS outpatient clinic. The Brazilian Journal of INFECTIOUS DISEASES 2013; 17(4): 438-443.

24 In the final regression model, lopinavir/r use [OR = 1.74 (95% CI: 1.12–2.86)] remained significantly and independently associated with dyslipidemia (high cholesterol and low HDL-C) after ART. Reference : Lauro Ferreira da Silva Pinto Neto, Mariza Barros das Neves, Rodrigo Ribeiro-Rodrigues, Kimberly Page, Angelica Espinosa Mirandab. Dyslipidemia and fasting glucose impairment among HIV patients three years after the first antiretroviral regimen in a Brazilian AIDS outpatient clinic. The Brazilian Journal of INFECTIOUS DISEASES 2013; 17(4): 438-443.

25 Reference: Hejazi N, Rajikan R, Kwok Choong CL, Suzana S. Metabolic abnormalities in adult HIV infected population on antiretroviral medication in Malaysia: a cross-sectional survey. BMC Public Health 2013; 13: 758.HejaziRajikanKwok Choong Risk factors for increased triglyceride (TG) in 1579 HIV subjects (normal = 646, increased TG = 933) on ARV medication Risk factors of high TG The result of logistic regression analysis (Table 2) revealed that significant risk factors (p < 0.001) for increasedTG level were increasing age (OR = 1.018, 95%CI = 1.008 -1.029), having hypertension (OR = 1.516, 95%CI = 1.173 - 1.960) and diabetes mellitus (OR = 1.532,95% CI = 1.150- 2.040), taking b- blockers as antihypertensive agents (OR = 1.668, 95% CI = −1.042), higher FPG (OR = 1.166, 95% CI = 1.084-1.253), higher CD4 cell count (OR = 1.001, 95% CI = 1.001-1.002), higher level of TC (OR = 1.281, 95% CI = 1.179 - 1.392) with following strong risks as low HDL level (OR = 3.585, 95% CI = 2.779-4.625), alcohol taking (OR = 2.653, 95% CI = 1.353- 5.202) and ARV therapy with PIs (OR = 2.309,95% CI = 1.605- 3.324). On the other hand being female (OR = 0.550, 95% CI = 0.428- 0.707) and Malay (OR = 0.676, 95% CI =0.464- 0.985), not taking anti- hyperglycemic agents(OR = 0.603, 95% CI = 0.419- 0.870), higher HDL level(OR = 0.485, 95% CI = 0.384- 0.612), having hepatitis disease(OR = 0.576, 95% CI = 0.424- 0.781) significantly reduce the risk of hypertriglyceridemia (p < 0.001). CD4 cell, viral load, LDL level and smoking were not associated with high TG level significantly (p > 0.05).

26 Risk factors for increased low-density lipoprotein cholesterol (LDL-C) level in 1578 HIV subjects (normal = 1023,increased LDL-C = 555) on ARV medication Reference: Hejazi N, Rajikan R, Kwok Choong CL, Suzana S. Metabolic abnormalities in adult HIV infected population on antiretroviral medication in Malaysia: a cross-sectional survey. BMC Public Health 2013; 13: 758.HejaziRajikanKwok Choong Risk factors of increased LDL In this study age, gender, taking ARV agents, medication with anti-hyperglycemic drugs, diabetes, smoking, alcohol consumption, CD4 cell, viral load and FPG level were not significant risk factor for high LDL (p > 0.05).Having hypertension (OR = 1.405, 95% CI = 1.093 –1.805)and diabetes mellitus (OR = 1.532, 95% CI = 1.150–2.040),higher TC level (OR = 6.468, 95% CI = 5.319–7.866) with following strong risk as normal HDL level (OR = 2.331,95% CI = 1.812–2.997) increased the risk (p < 0.05) for high LDL level (Table 3).Conversely being Chinese (OR = 0.551, 95% CI = 0.434–0.701), lower TG level (OR = 0.858, 95% CI = 0.800– 0.920),and having hepatitis disease (OR = 0.592, 95% CI = 0.419–0.836), significantly protect the subjects from increasedLDL level (p < 0.001).

27 Risk factors for low high-density lipoprotein (HDL) level in 1582 HIV subjects (normal = 1128, low HDL = 454) on ARV medication Reference: Hejazi N, Rajikan R, Kwok Choong CL, Suzana S. Metabolic abnormalities in adult HIV infected population on antiretroviral medication in Malaysia: a cross-sectional survey. BMC Public Health 2013; 13: 758.HejaziRajikanKwok Choong Risk factors of low HDL Also Table 5 shows that the risk of low HDL level was significantly (p < 0.001) related to the factors including being Chinese (OR = 1.753, 95% CI = 1.187–2.589), taking antihyperglycemic agent (OR = 1.636, 95% CI = 1.152–2.323), higher LDL level (OR = 1.709, 95% CI = 1.516–1.926),increased level of TC ≥ 5.17 (OR =1.867, 95% CI = 1.498– 2.327) and ARV therapy with PIs (OR = 1.449, 95% CI =1.037–2.024). Beside this study showed that being Indian(OR = 0.570, 95% CI = 0.386– 0.842), higher level of TG(OR = 0. 693, 95% CI = 646–0.745) and having hepatitis disease (OR = 0.630, 95% CI = 0.459–0.865) significantly decreased the risk of low HDL level (p < 0.001). Age,gender, hypertension, b-blocker, diabetes mellitus, FPG,alcohol consumption, smoking were not associated with low level of HDL.

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