Serum Uric Acid and High-sensitivity C-reactive Protein Levels Among People Living with HIV on Dolutegravir and Ritonavir-boosted Atazanavir-based Antiretroviral Therapy: a Comparative Cross-sectional Study

Overview

Journal Front Med (Lausanne)

Specialty General Medicine

Date 2024 Aug 1

PMID 39086939

Authors

Nuredin Chura Waritu

Suresh Kumar P Nair

Rashed Edris Usure

Mohammed Jemal

Affiliations

Soon will be listed here.

Abstract

Background: After the introduction of antiretroviral therapy, the care given to people living with HIV has become complicated by the appearance of comorbidities as a result of HIV and HAART toxicities, in which cardiovascular disease got the most attention. So, this study aimed to assess serum uric acid and high-sensitivity C-reactive protein levels among people living with HIV on dolutegravir (DTG) and ritonavir-boosted atazanavir (ATV/r)-based therapy.

Methods: An institutional-based comparative cross-sectional study was conducted from November 4, 2021, to January 4, 2022. An equal number of dolutegravir- and ritonavir-boosted atazanavir-treated patients ( = 86 each) were enrolled. A consecutive sampling method was used to select participants. Data were entered into Epidata version 4.6, exported to SPSS version 25.0, and analyzed using Chi-square, Student's t-test, Mann-Whitney -test, and logistic regression. Statistical significance was set at < 0.05.

Results: The prevalence of hyperuricemia and high-sensitivity C-reactive protein levels ≥2 mg/L were 46.5% (40/86) and 24.4% (21/86) in the DTG group, and 30.2% (26/86) and 44.2 (38/86) in the ATV/r group, respectively. When compared to ATV/r, a higher mean level of uric acid was found among DTG-based regimens (5.38 mg/dL). Duration of ART (AOR = 2, 95% CI: 1.2, 4.4) and DTG-based regimen (AOR = 1.9, 95% CI: 1.04, 3.8) were significant predictors of developing hyperuricemia. ATV/r-based regimen (AOR = 3, 95% CI: 1.5, 8.3) and high waist circumference (AOR = 2.5, 95% CI: 1, 3.5) were significantly associated with increased high-sensitivity C-reactive protein levels.

Conclusion: It is observed that DTG-based and ATV/r-based ART are associated with hyperuricemia and increased high-sensitivity C-reactive protein levels, respectively. Therefore, it is important to consider and evaluate serum uric acid and high-sensitivity C-reactive protein levels in patients taking DTG and ATV/r-based ART, as well as among those on HAART for years and with a higher waist circumference, so as to detect and prevent early the risk of having CVD.

Citing Articles

Atherogenic Index of Plasma and High-Sensitivity C-Reactive Protein Levels Among People Living With HIV on Dolutegravir and Ritonavir-Boosted Atazanavir-Based Antiretroviral Therapy and Their Correlations to CD4 Cell Counts.

Waritu N, Usure R, Adema B, Wakeyo M, Jemal M AIDS Res Treat. 2025; 2025:1468678.

PMID: 39834358 PMC: 11745559. DOI: 10.1155/arat/1468678.

References

Nardi V, Franchi F, Prasad M, Fatica E, Alexander M, Bois M . Uric Acid Expression in Carotid Atherosclerotic Plaque and Serum Uric Acid Are Associated With Cerebrovascular Events. Hypertension. 2022; 79(8):1814-1823. DOI: 10.1161/HYPERTENSIONAHA.122.19247. View

Ridker P, MacFadyen J, Glynn R, Bradwin G, Hasan A, Rifai N . Comparison of interleukin-6, C-reactive protein, and low-density lipoprotein cholesterol as biomarkers of residual risk in contemporary practice: secondary analyses from the Cardiovascular Inflammation Reduction Trial. Eur Heart J. 2020; 41(31):2952-2961. PMC: 7453833. DOI: 10.1093/eurheartj/ehaa160. View

de Lima L, Luiz Petroski E, Moreno Y, Silva D, Trindade E, Carvalho A . Dyslipidemia, chronic inflammation, and subclinical atherosclerosis in children and adolescents infected with HIV: The PositHIVe Health Study. PLoS One. 2018; 13(1):e0190785. PMC: 5761890. DOI: 10.1371/journal.pone.0190785. View

Auclair M, Guenantin A, Fellahi S, Garcia M, Capeau J . HIV antiretroviral drugs, dolutegravir, maraviroc and ritonavir-boosted atazanavir use different pathways to affect inflammation, senescence and insulin sensitivity in human coronary endothelial cells. PLoS One. 2020; 15(1):e0226924. PMC: 6977740. DOI: 10.1371/journal.pone.0226924. View

Aberg J, Tebas P, Overton E, Gupta S, Sax P, Landay A . Metabolic effects of darunavir/ritonavir versus atazanavir/ritonavir in treatment-naive, HIV type 1-infected subjects over 48 weeks. AIDS Res Hum Retroviruses. 2012; 28(10):1184-95. PMC: 3448095. DOI: 10.1089/aid.2011.0327. View

Lee C, You N, Song Y, Hsu Y, Manson J, Nathan L . Relation of genetic variation in the gene coding for C-reactive protein with its plasma protein concentrations: findings from the Women's Health Initiative Observational Cohort. Clin Chem. 2008; 55(2):351-60. PMC: 2856608. DOI: 10.1373/clinchem.2008.117176. View

Fernandes S, Leite A, Lino R, Guimaraes A, Pineiro C, Serrao R . The impact of integrase inhibitors on steatosis and fibrosis biomarkers in persons with HIV naïve to antiretroviral therapy. BMC Infect Dis. 2023; 23(1):553. PMC: 10464196. DOI: 10.1186/s12879-023-08530-3. View

Hamed M, Aremu G, Akhigbe R . Concomitant administration of HAART aggravates anti-Koch-induced oxidative hepatorenal damage via dysregulation of glutathione and elevation of uric acid production. Biomed Pharmacother. 2021; 137:111309. DOI: 10.1016/j.biopha.2021.111309. View

Osegbe I, Soriyan O, Ogbenna A, Okpara H, Azinge E . Risk factors and assessment for cardiovascular disease among HIV-positive patients attending a Nigerian tertiary hospital. Pan Afr Med J. 2016; 23:206. PMC: 4907765. DOI: 10.11604/pamj.2016.23.206.7041. View

10.

Hongo H, Nagao T, Nakamura K, Kitaichi T, Maeno Y, Tokunaga T . Safety and Effectiveness Analysis of Dolutegravir in Patients with HIV-1: Interim Report of Post-Marketing Surveillance in Japan. Adv Ther. 2021; 38(8):4480-4504. PMC: 8342375. DOI: 10.1007/s12325-021-01842-3. View

11.

Spiga R, Marini M, Mancuso E, Di Fatta C, Fuoco A, Perticone F . Uric Acid Is Associated With Inflammatory Biomarkers and Induces Inflammation Via Activating the NF-κB Signaling Pathway in HepG2 Cells. Arterioscler Thromb Vasc Biol. 2017; 37(6):1241-1249. DOI: 10.1161/ATVBAHA.117.309128. View

12.

Wang X, Xiao J, Zhang L, Liu Y, Chen N, Deng M . Longitudinal analysis of immune reconstitution and metabolic changes in women living with HIV: A real-world observational study. Chin Med J (Engl). 2023; 136(18):2168-2177. PMC: 10508409. DOI: 10.1097/CM9.0000000000002756. View

13.

Kelesidis T, Tran T, Stein J, Brown T, Moser C, Ribaudo H . Changes in Inflammation and Immune Activation With Atazanavir-, Raltegravir-, Darunavir-Based Initial Antiviral Therapy: ACTG 5260s. Clin Infect Dis. 2015; 61(4):651-60. PMC: 4542595. DOI: 10.1093/cid/civ327. View

14.

Waritu N, Nair S, Birhan B, Adugna T, Awgichew G, Jemal M . Serum Lipid Profiles, Blood Glucose, and High-Sensitivity C-Reactive Protein Levels Among People Living with HIV Taking Dolutegravir and Ritonavir-Boosted Atazanavir-Based Antiretroviral Therapy at Jimma University Medical Center, Southwest.... HIV AIDS (Auckl). 2024; 16:17-32. PMC: 10873129. DOI: 10.2147/HIV.S430310. View

15.

De Luca A, de Gaetano Donati K, Colafigli M, Cozzi-Lepri A, De Curtis A, Gori A . The association of high-sensitivity c-reactive protein and other biomarkers with cardiovascular disease in patients treated for HIV: a nested case-control study. BMC Infect Dis. 2013; 13:414. PMC: 3846422. DOI: 10.1186/1471-2334-13-414. View

16.

Martinez E, DAlbuquerque P, Llibre J, Gutierrez F, Podzamczer D, Antela A . Changes in cardiovascular biomarkers in HIV-infected patients switching from ritonavir-boosted protease inhibitors to raltegravir. AIDS. 2012; 26(18):2315-26. DOI: 10.1097/QAD.0b013e328359f29c. View

17.

Randell P, Jackson A, Milinkovic A, Boffito M, Moyle G . An open-label, randomized study of the impact on insulin sensitivity, lipid profile and vascular inflammation by treatment with lopinavir/ritonavir or raltegravir in HIV-negative male volunteers. Antivir Ther. 2016; 22(2):145-151. DOI: 10.3851/IMP3098. View

18.

Getahun Z, Azage M, Abuhay T, Abebe F . Comorbidity of HIV, hypertension, and diabetes and associated factors among people receiving antiretroviral therapy in Bahir Dar city, Ethiopia. J Comorb. 2020; 10:2235042X19899319. PMC: 7076577. DOI: 10.1177/2235042X19899319. View

19.

Alter G, Suscovich T, Kleyman M, Teigen N, Streeck H, Zaman M . Low perforin and elevated SHIP-1 expression is associated with functional anergy of natural killer cells in chronic HIV-1 infection. AIDS. 2006; 20(11):1549-51. DOI: 10.1097/01.aids.0000237371.31315.48. View

20.

Llibre J, Buzon M, Massanella M, Esteve A, Dahl V, Puertas M . Treatment intensification with raltegravir in subjects with sustained HIV-1 viraemia suppression: a randomized 48-week study. Antivir Ther. 2012; 17(2):355-64. DOI: 10.3851/IMP1917. View