Liu, EnjuArmstrong, CatharinaSpiegelman, DonnaChalamilla, GuerinoNjelekela, MarinaHawkins, ClaudiaHertzmark, EllenLi, NanAris, EricMuhihi, AlfaSemu, HelenFawzi, Wafaie2019-09-212013Liu, Enju, Catharina Armstrong, Donna Spiegelman, Guerino Chalamilla, Marina Njelekela, Claudia Hawkins, Ellen Hertzmark, et al. 2013. “First-Line Antiretroviral Therapy and Changes in Lipid Levels Over 3 Years Among HIV-Infected Adults in Tanzania.” Clinical Infectious Diseases 56 (12): 1820–28. https://doi.org/10.1093/cid/cit120.1066-226X1071-6564http://nrs.harvard.edu/urn-3:HUL.InstRepos:41384725Background. With the rapid rollout of antiretroviral therapy (ART) in sub-Saharan Africa (SSA), there has been an increasing concern about cardiovascular risks related to ART. However, data from human immunodeficiency virus (HIV)-infected populations from this region are very limited.Methods. Among 6385 HIV-infected adults in Dar es Salaam, Tanzania, we investigated the nonfasting lipid changes over 3 years following ART initiation and their associations with different first-line ART agents that are commonly used in SSA. Results. In the first 6 months of ART, the prevalence of dyslipidemia decreased from 69% to 54%, with triglyceride (TG) decreasing from 127 mg/dL to 113 mg/dL and high-density lipoprotein (HDL) cholesterol increasing from 39 mg/dL to 52 mg/dL. After 6 months, TG returned to its baseline level and increased to 139 mg/dL at 3 years; total cholesterol and low-density lipoprotein cholesterol continued to increase whereas HDL cholesterol leveled off. The prevalence of dyslipidemia increased to 73% after a 3-year follow-up. In multivariate analyses, patients on zidovudine-containing regimens had a greater reduction in TG levels at 6 months (-16.0 vs -6.3 mg/dL), and a lower increase at 3 years compared to patients on stavudine-containing regimens (2.1 vs 11.7 mg/dL, P < .001); patients on nevirapine-based regimens had a higher increase in HDL cholesterol levels at 3 years compared to those on efavirenz-based regimens (13.6 vs 9.5 mg/dL, P = .01). Conclusions. Our findings support the latest World Health Organization guidelines on the substitution of stavudine in first-line ART in resource-limited settings, and provide further evidence for selection of lipid-friendly ART for patients in SSA.en-USJournal Article2019-09-2110.1093/cid/cit120