3.1. Socio-demographic and Characteristics of Study Participants
A total of 228 HIV positive persons were enrolled in this study from whom, majority, 125 (54.82 %) were females. Majority of study participants were within the age group of 31–40 years. The mean age of study participants was 35.31 (± 7.20). The majority of patients can read and write.
Majority (61.4%) of the patients are urban residents. 29 (12.8%) of the patients had smoking history (Table 1).
Table 1
Socio-demographic characteristics of HIV patients on HAART and HAART naïve in Debre Tabor referral hospital, Debre Tabor, Ethiopia, 2020.
Variable | Categories | On HAART | HAART naïve |
Sex | Male | 53 | 50 |
Female | 61 | 64 |
Age | 18–30 | 24 | 32 |
31–40 | 67 | 62 |
> 40 | 31 | 20 |
Educational status | Illiterate | 15 | 19 |
Read and write | 69 | 70 |
Diploma &above | 30 | 25 |
Residence | Rural | 46 | 42 |
Urban | 68 | 72 |
Smoking habit | Yes | 17 | 12 |
No | 97 | 102 |
Physical exercise | Yes | 39 | 42 |
No | 75 | 72 |
3.2 Clinical characteristics of study participants
49 (21.5%) of the study participants were obese. 99 (43.4%) of the study participants were hypertensive. 68 (29.8%) of the participants have a CD4 count of < 350 cells/mm3, while 103 (45.2%) have a CD4 count of 350–550 cells/mm3 and 57 (25%) of the participants have a CD4 count of > 550 cells/mm3 (Table 2).
Table 2
clinical parameters of HIV patients on HAART and HAART naïve in Debre Tabor referral hospital, Debre Tabor, Ethiopia, 2020.
Variable | Categories | On HAART | HAART naïve |
BMI (Kg/m2) | < 18.5 | 5 | 9 |
18.5–25 | 78 | 87 |
> 25 | 31 | 18 |
Blood pressure (MmHg) | < 140/90 | 61 | 68 |
≥ 140/90 | 53 | 46 |
CD4 cells/mm3 | < 350 | 19 | 49 |
350–550 | 52 | 51 |
> 550 | 43 | 14 |
N.B: HAART = highly active antiretroviral therapy, No = Number, BMI = Body Mass Index, Kg/m2 = Kilo gram per Meter squire, *blood pressure as systolic/diastolic, ZDV = Zidovudine, 3TC = Lamivudine, EFV = Efavirenz, NVP = Neverapine, TDF = Tenofovir, LPV/r = Lopinavir/r |
3.3 Lipid Profile of study participants
Majority (63.6%) of the study participants have dyslipidemia. 91(39.9%) of the study participants have a total cholesterol of ≥ 200mg/dl. 91 (39.9%) of study participants have diminished level of HDL-c (< 40 mg/dl). 87(38.1%) of the study participants have elevated level of LDL-c (> 130 mg/dl). 112 (49.1%) of the study participants have elevated level of TG (> 150 mg/dl) (Table 3).
Table 3
Serum lipid profile of study population by HAART status in Debre Tabor referral Hospital, Debre Tabor -Ethiopia from July 20 to August 13, 2020.
Variable | Categories | On HAART No (%) | HAART naïve No (%) |
Total dyslipidemia | Absent | 30 (26.3) | 53 (46.5) |
Present | 84 (73.7) | 61 (53.5) |
TC | < 200 mg/dl | 57 (50) | 80 (70.2) |
≥ 200mg/dl | 57 (50) | 34 (29.8) |
HDL-c | < 40 mg/dl | 50 (43.85) | 41 (36) |
≥ 40 mg/dl | 64 (56.15) | 73 (64) |
LDL-c | < 130 mg/dl | 59 (51.75) | 82 (71.9) |
≥ 130 mg/dl | 55 (48.25) | 32 (28.1) |
TG | < 150 mg/dl | 46 (40.4) | 70 (61.4) |
| ≥ 150 mg/dl | 68 (59.6) | 44 (38.6) |
N.B: NO = Number, HAART = highly active antiretroviral therapy, TC = total cholesterol, HDL-c = High-Density Lipoprotein-cholesterol, LDL-c = Low-Density Lipoprotein-cholesterol, TG = triglyceride, TC/HDL-c ratio = total cholesterol/High-Density Lipoprotein-cholesterol ratio
3.4. Associated Risk Factors of Dyslipidemia
Among the study participants involved, 84 (73.68%) on HAART and 61 (53.51%) HAART naive persons had at least one lipid abnormality. The prevalence of dyslipidemia on HAART for TC, LDL-c & TG was greater than HAART naïve which was significantly different. The Mean value of TC, LDL-c and TG were higher in persons on HAART than in HAART-naïve whereas the mean value of HDL-c was higher among HAART-naïve than on HAART HIV positive persons (Table 3 &4).
Table 4. Comparison of the mean of variables by HAART status at Debre Tabor Hospital, Debre Tabor -Ethiopia from July 20 to August 13, 2020.
|
Variable
|
|
Group
|
|
Mean (SD)
|
|
t (95% CI)
|
|
P-value
|
|
|
|
|
|
|
|
|
Age in years
|
|
HAART naïve
|
|
34.42 (6.49)
|
|
|
|
|
|
|
|
|
|
On HAART
|
|
36.3 (7.81)
|
|
1.9
|
(0.01, 3.74)
|
|
0.318
|
|
|
TC
|
|
HAART naïve
|
|
186
|
(24.09)
|
|
|
|
|
|
|
|
|
|
On HAART
|
|
202
|
(23.98)
|
|
4.9
|
(9.41, 21.88)
|
|
<0.001
|
|
|
HDL-c
|
|
HAART naïve
|
|
43.85 (7.91)
|
|
|
|
|
|
|
|
|
|
On HAART
|
|
40.52 (6.09)
|
|
-3.49 (-5.18, -1.53)
|
|
<0.001
|
|
|
LDL-c
|
|
HAART naïve
|
|
111.35 (24.79)
|
|
|
|
|
|
|
|
|
|
On HAART
|
|
126
|
(22.86)
|
|
4.6
|
(8.84, 19.81)
|
|
<0.001
|
|
|
TG
|
|
HAART naïve
|
|
155
|
(23.34)
|
|
|
|
|
|
|
|
|
|
On HAART
|
|
175
|
(36.81)
|
|
5.11 (11.90, 28.16)
|
|
<0.001
|
|
|
CD4 Cells/mm3
|
|
HAART naïve
|
|
339
|
(75.88)
|
|
|
|
|
|
|
|
|
|
On HAART
|
|
500
|
(157.25)
|
|
9.9
|
(128.55, 193.13)
|
|
<0.001
|
|
|
BMI in kg/m2
|
|
HAART naïve
|
|
22.11 (2.63)
|
|
|
|
|
|
|
|
|
|
On HAART
|
|
23.33 (2.72)
|
|
3.4
|
(0.54, 1.92)
|
|
0.862
|
|
Multivariable logistic regression analysis was done for variables having p < 0.25 in binary logistic regression analysis (Age, CD4 count, BMI, blood pressure, and HAART status). After controlling potential confounding factors in multiple logistic regression analysis; age greater than 40 years old (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 > 25kg/m2 (AOR = 1.92, 95 % C.I: 1.20–4.81) were identified as determinants of Dyslipidemia (Table 5).
Table 5. Associations of variables with dyslipidemia among persons on HAART and HAART naive in Debre Tabor Hospital, Debre Tabor -Ethiopia from July 20 to August 13, 2020
Outcome variables in mg/dl (95 % CI)
Explanatory Variable
|
|
|
|
|
|
|
|
|
|
|
|
|
TC ≥ 200
|
|
HDL-c < 40
|
|
LDL-c ≥ 130
|
|
TG ≥ 150
|
|
|
|
|
|
|
|
|
Male
|
COR
|
1.01(0.58-1.72)
|
1.6(0.57-1.63)
|
1.10(0.65-1.92)
|
1.23(0.71-2.01)
|
|
|
P-value
|
0.990
|
0.880
|
0.720
|
0 .510
|
|
Age>40 years
|
COR
|
4.88 (2.05-11.61)
|
4.32(1.12-16.54)
|
4.05(1.77-9.27)
|
9.20(2.39-35.49)
|
|
|
P-value
|
|
0 .001
|
0.030
|
0.001
|
<0.001
|
|
CD4 <350 cells/mm3
|
COR
|
|
3.31(1.50-7.28)
|
|
2.06(0.96-4.44)
|
4.00(1.80-8.87)
|
3.39(1.52-7.58)
|
|
|
P
|
|
0 .003
|
|
0.062
|
|
0 .001
|
0.003
|
|
BMI>25kg/m2
|
COR
|
|
2.01(1.34-6.15)
|
|
5.22(2.63-10.72)
|
|
3.20(1.71-7.55)
|
|
10.83(1.38-84.37)
|
|
|
P-value
|
|
<0.011
|
|
<0.001
|
|
<0.001
|
|
<0.001
|
|
On HAART
|
COR
|
|
2.34(1.36-4.02)
|
|
1.44(0.85-2.41)
|
|
2.46(1.42-4.23)
|
|
2.53(1.49-4.31)
|
|
|
P-value
|
|
0 .002
|
|
0 .180
|
|
0 .001
|
|
<0.001
|
|
Blood pressure ≥140 /90*
|
COR
|
|
25.32(12.43-51.59)
|
|
8.01(4.40-14.57)
|
|
16.87(8.62-33.01)
|
|
9.44(5.12-17.41)
|
|
|
P-value
|
|
<0.001
|
|
<0.001
|
|
<0.001
|
|
<0.001
|
|
N.B: COR = Crude Odes Ratio, CI = Confidence Interval, TC = total cholesterol, HDL-c = High-Density Lipoprotein-cholesterol, LDL-c = Low-Density Lipoprotein-cholesterol, TG = triglyceride, BMI = Body Mass Index, HAART = highly active antiretroviral therapy, *blood pressure as systolic/diastolic
Table 6. Determinant factors of Dyslipidemia and lipid profile level among HIV positive persons, adjusted for the potential confounding factors of study participants in Debre Tabor Hospital, Debre Tabor -Ethiopia from July 20 to August 13, 2020
|
Explanatory Variable
|
|
|
|
Dyslipidemia
|
|
|
lipid profile level in mg/dl (95 % CI)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TC ≥ 200
|
|
HDL-c < 40
|
|
LDL-c ≥ 130
|
|
TG ≥ 150
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Age>40 years old
|
|
AOR
|
3.27(1.47-7.25)
|
|
|
|
|
|
|
|
2.44(1.06-5.64)
|
|
|
|
|
|
P-value
|
0.004
|
|
|
|
|
|
|
|
0.037
|
|
|
BMI>25kg/m2
|
|
|
AOR
|
|
1.92(1.20-4.81)
|
|
|
2.31(1.04-7.66)
|
|
|
|
3.20(1.71-7.55)
|
|
10.83(1.38-
|
|
|
|
|
|
|
|
|
|
|
|
84.37)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
P-value
|
0.044
|
|
0.025
|
|
|
<0.001
|
|
<0.001
|
|
|
On HAART
|
|
|
AOR
|
2.73(1.35-5.53)
|
|
3.15(1.49-6.68)
|
|
|
3.02(1.42-4.23)
|
|
2.87(1.51-5.45)
|
|
|
|
|
|
P-value
|
0.005
|
|
0 .003
|
|
|
0 .002
|
|
0.001
|
|
|
|
|
|
AOR
|
|
16.13(5.81-44.75)
|
|
|
28.59(13.39-
|
|
5.24(2.69-
|
|
18.44(9.10-
|
|
7.08(3.45-14.53)
|
|
|
Blood pressure ≥140 /90
|
|
|
|
|
|
61.04)
|
|
10.22)
|
|
37.41)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
P-value
|
<0.001
|
|
|
<0.001
|
|
<0.001
|
|
<0.001
|
<0.001
|
|
N.B: AOR = Adjusted Odes Ratio, CI = Confidence Interval, TC = total cholesterol, HDL-c = High-Density Lipoprotein-cholesterol, LDL-c = Low-Density Lipoprotein