Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 105941

AbstractMaterial and MethodsResultsDiscussionConclusionAcknowledgementReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : December | Volume : 16 | Issue : 12 | Page : BC06 - BC09 Full Version

Effect of Antiretroviral Therapy on Circulating Lipid Levels in Human Immunodeficiency Virus Infected Patients: A Cross-sectional Study

Published: December 1, 2022 | DOI:
RN Devaki, Hasit Kumar D Lad, Rana Neetaben Maheshchandra, N Chandrika

1. Professor and Head, Department of Biochemistry, Chamarajanagar Institute of Medical Sciences, Chamarajanagar, Karnataka, India. 2. Associate Professor, Department of Biochemistry, SMIMER Medical College, Surat, Gujarat, India. 3. Postgraduate Student, Department of Biochemistry, SMIMER Medical College, Surat, Gujarat, India. 4. Associate Professor, Department of Biochemistry, Chamarajanagar Institute of Medical Sciences, Chamarajanagar, Karnataka, India.

Correspondence Address :
N Chandrika,
No. 7, ‘Santushti’, Survey No. 79/1, Srikrishna Layout, Srirampura, Mysuru-570008, Karnataka, India.


Introduction: The antiretroviral drugs have improved the quality and extent of life of Human Immunodeficiency Virus (HIV) infected patients, yet like any other long-term medication, these are known to cause several adverse effects. One such adverse effect is on the lipid metabolism in individuals on Antiretroviral Therapy (ART).

Aim: To analyse the effect of ART on the circulating lipid levels in HIV patients. The secondary aim was to compare the lipid changes in patients treated with ZLN (Zidovudine+Lamivudine+Nevirapine) drug regimen against those, with TLE (Tenofovir+Lamivudine+Efavirenz).

Materials and Methods: This cross-sectional study was conducted from December 2019 to March 2021 at the District Hospital, Chamarajanagar Karnataka, India. A total of 200 HIV positive patients between 18-55 years of age with no associated co-morbidities and who have been on ART were recruited into this study. Of the total 91 patients were on TLE (Tenofovir+ Lamivudine+ Efavirenz) and 109 were on ZLN (Zidovudine+ Lamivudine+Nevirapine) regimen. Blood samples were collected from all the patients and lipid profile analysis was done.

Results: Statistically significant increase was observed in all lipid parameters in the ZLN group compared to TLE group. Serum Total Cholesterol (TC) {ZLN 190.92±43.57 vs 164.23±40.7 in TLE group (p-value <0.0001)} serum Low Density Lipoprotein Cholesterol (LDL-C) {ZLN 120.44±35.46 vs 100.81±26.84 in TLE group (p-value <0.0001)}, Triglyceride (TG) {ZLN 245.68±132.42 vs 171.56±77.30 in TLE group (p-value <0.0001)} and High Density Lipoprotein Cholesterol (HDL-C) {ZLN 60.71±17.51 vs 53.31±13.8 in TLE group (p-value=0.0012)}. Also the non HDL-C levels {ZLN 130.2±39.51 vs 110.91±36.87 in TLE group (p-value <0.0005)} were higher in patients receiving ZLN drug regimen than those who were on TLE. Of the 200 HIV patients, 53 were taking ART for less than five years (mean 2.51±1.12 years), 109 were receiving ART between 5-10 years (mean 7.78±1.50 years), 38 patients were on ART treatment for more than 10 years (mean 11.73±0.76 years). A positive significant association between lipid derangement and disease/ART duration was observed.

Conclusion: Lipid abnormalities were more in HIV patients on ZLN drug regimen, than those on TLE regimen. The longer course of disease/ART is associated with imminent lipoprotein derangement. Periodic monitoring of lipid levels are recommended in these patients.


Dyslipidaemia, Lipid metabolism, Nucleoside reverse transcriptase inhibitor

Human Immunodeficiency Virus (HIV) is a retrovirus that infects cells of the human immune system, mainly CD4 cells and destroys or impairs their function (1). Acquired Immunodeficiency Syndrome (AIDS) describes the collection of symptoms and infections associated with acquired deficiency of the immune system. Infection with HIV has been established as the underlying cause of AIDS (2). The Joint United Nations Programme on HIV/AIDS (UNAIDS) has reported that 38.4 million people are living with HIV infection in the world and 1.5 million newly got infected with HIV in the year 2021 (3). In India, The National AIDS Control Organisation (NACO) report of 2019 states that, there are 23.48 lakh people living with HIV infection in India among which 2.69 lakh people are from Karnataka state (4).

Lipid derangement is one of the commonly encountered adverse effects of ART (5). Individuals infected with HIV are vulnerable to lipid derangement, both due the infection and the drugs with which they are treated (6). Though the intense ART has established a triumph of transforming the fatal HIV infection into a chronic manageable disease, the associated dyslipidaemia in these patients make them prone to cardiovascular disease. Cardiovascular disease is the second (after malignancy) non infection related cause of death in HIV infected patients in the world (7). Thus, the benefits of ART may be sabotaged by the untoward consequence of associated side-effects.

There have been various studies in the recent past which have shown the adverse influence of ART on lipid levels in individuals taking these medications. Ombeni W and Kamuhabwa AR, have observed varied prevalence of dyslipidaemia in HIV patients on ART (8). A research project undertaken by Ceccato MGB et al., reports lipid derangement in HIV individuals taking ART (9). Singh J et al., have made a revelation after conducting their study that HIV infection alone causes alterations in lipid levels (10).

The researches reporting these findings are extremely limited from Chamarajanagar, the southern-most district of Karnataka, India. The aim of the study was to analyse the effect of ART drugs on the circulating lipid levels in HIV patients in this region. The second objective was to compare the lipid changes in HIV patients treated with ZLN drug regimen against those with TLE. The study also aimed to examine the association of duration of the disease/ART with lipid levels in these patients.

Material and Methods

The cross-sectional study was conducted from December 2019 to March 2021 at the Antiretroviral Centre of the District Hospital, Chamarajanagar, which is also the Teaching Hospital, associated to Chamarajanagar Institute of Medical Sciences, Chamarajanagar, Karnataka, India. The approval from Institutional Ethics Committee (IEC) was obtained (Letter no. CIMS/IEC-01/2018-2019, dated 06/09/2019). An informed consent was taken from all 200 HIV patients who were included into the study. The patients were ensured confidentiality about their identity.

Inclusion criteria: HIV patients on ART between 18 and 55 years of age with no acute infections.

Exclusion criteria: HIV patients with other medical or surgical co-morbidities, defaulters and pregnant ladies.

Sample size calculation: The sample size was calculated based on the HIV patient turnover at the study centre. On an average was 190 patients visited the centre in a month. Based on the Yamane equation, n=N/1+Ne2.

n=Sample size
N-Known Population
e-Margin of error (for 95% confidence level, Margin of error=0.05).

The calculation made by using the above formula, a sample size of 200 HIV patients was estimated and incorporated in the study.

Among 200 HIV patients, 109 were on ZLN (Zidovudine+Lamivudine+Nevirapine) and 91 were on TLE (Tenofovir+Lamivudine+Efavirenz) regimen. They were assigned as ZLN and TLE groups respectively.

Study Procedure

A random blood sample was drawn from all 200 patients and Biochemical parameters were estimated on fully automated Chemistry analyser, ERBA XL-640. Though the lipid profile test is processed ideally on a fasting blood sample, to encourage the participants, who were hesitant to undergo blood investigation, relaxation of the clause of giving a fasting blood sample to a random sample was made which encouraged them to enroll into the research project. Recent studies prophases that serum TC, HDL and LDL-c estimation do not require fasting status for analysis and if TG are estimated in a random blood sample, then by extending its normal reference range to <175 mg/dL, the TG levels can be interpreted (11). In the current study, these guidelines are incorporated to assess the lipid parameters analysed on a random sample.

The random blood glucose was estimated by glucose oxidase peroxidase method. Serum creatinine (by Jaffe’s method) and Blood urea (Urease/Glutamate Dehydrogenase method) levels were measured in these patients, to rule out possible kidney dysfunction and only those whose levels were within in the normal reference range were included in the study. The serum TC was measured by Cholesterol Oxidase-phenol 4-aminoantipyrine peroxidase method. Serum High Density Lipoprotein cholesterol (HDL-c) and Low Density Lipoprotein cholesterol (LDL-c) assays were done by direct methods.

Serum TG was analysed by Glycerol-3-phosphate Oxidase-Peroxidase method. The rest are the calculated parameters. Very Low Density Lipoprotein (VLDL) is calculated as TGL/5. Non HDL-c=TC:HDL-c.

Statistical Analysis

The results were compiled and tabulated on Microsoft Excel software. Following descriptive statistics were employed in the present study- Mean, standard deviation, frequency and percent. For inferential statistical analysis, Chi-square test procedure which tabulates a variable into categories and computed Chi-square statistic was used. Fisher’s-Exact significance values were considered, when cell entries were less.


The mean age of the participants was 39.66 years, gender distribution is shown in (Table/Fig 1). (Table/Fig 2) shows comparison of Mean±SD of lipid parameters between HIV patients taking ZLN with TLE regimen.

There was a statistically significant elevation in the lipid parameters in those with the disease and on ART between five and 10 years as against to those for less than five years. However no significant change in lipid levels was observed between those with disease and on ART duration of 5-10 years and those who were for more than 10 years (Table/Fig 3).

The levels of HDL-c, LDL-c, TC were significantly increased as the disease/ART duration increased (Table/Fig 4).


The mean serum TC, HDL-c, and Non-HDl-c were within the normal reference ranges for the entire group. Zhou DT et al., also reported that the lipid levels were within reference range in their study (12). Serum LDL-c, and TG levels were however elevated in the current study populace. The same was observed and reported Wafai N et al., in their study on HIV patients (13). In a study conducted in Ethopia on HIV patients on first line ART, Tadewos A et al., have reported hypertriglyceridaemia (14). Increase in TG levels in HIV positives was also observed by Dave JA et al., in a project done in South Africa (15).

The HIV patients in the present study largely constituted patients prescribed with combination regimen of Zidovudine (300 mg)+Lamivudine (150 mg)+Nevirapine (200 mg) twice daily regimen and Tenofovir (300 mg)+Lamivudine (300 mg)+Efavirenz (600 mg) once daily regimen. In the ZLN combination, Zidovudine and Lamivudine are drugs belonging to Nucleoside Reverse Transcriptase Inhibitors (NRTI), Nevirapine is a Non Nucleoside Reverse Transcriptase Inhibitor (NNRTI). Similarly, among TLE drugs Tenofovir is a Nucleotide Reverse transcriptase inhibitor (NtRTI) and Efavirenz is non Nucleoside Reverse transcriptase inhibitor. After analysing and comparing lipids components of patients between the groups, the lipid dysfunction appears to be more in the group prescribed with ZLN regimen. All the lipid particles, TC, TG, LDL-c were significantly elevated in patients on ZLN therapy compared to TLE. This was in accordance with findings by Gurav N et al., who have reported hypertriglyceridaemia and hypercholesterolaemia in HIV patients on ZLN compared to patients, who were on TLE (16). Apart from this, the current study reports a significant increase in HDL-c levels in patients on ZLN than in TLE group. Study by Van Leth F et al., have compared Nevirapine (NVP) and Efavirenz (EFV) with regard to lipid response they elicit in HIV patients and have found that NVP-containing ART shows larger increases in HDL-c and decreases in TC:HDL-c ratio than an EFV-containing regimen (17).

Several studies have compared ZLN with TLE drug regimen with respect to change in CD4 count and emergence of opportunistic infections (18); immunological outcome and effect on liver function (19); adverse effects (20); clinical and immunological responses (21). In all these research projects TLE regimen therapy outcome has emerged better than ZLN. Gallant JE et al., observed that, when tenofovir was compared to zidovudine, there was significantly smaller increase in total cholesterol and LDL-c observed with tenofovir use (22).

The HIV infected patients in the present study were on ART for two years till more than 13 years. The study intruded into explore whether an association with degree of dyslipidaemia and duration of the disease/ART existed. It was noticed that, a positive correlation existed between serum TC, HDL-c ad LDL-c levels and disease/ART duration. This was in accordance with the findings by Kemal A et al., who also report association between dyslipidaemia and duration of ART, in Ethiopia (23).

There are several in-vitro and in-vivo studies which have demonstrated that HIV infection prompts dyslipidaemia. The retro virus, HIV, stimulates lipogenesis in the liver and alters lipid profile of the host (6). The virus induces synthesis of enzymes and proteins that promotes fatty acid synthesis and increases the LDL-c, TGL levels in the circulation. It also alters lipid metabolism, transport and stimulates oxidation of circulating lipoproteins (24). With the initiation of ART, the lipid derangement appears to fall back to baseline (25). However, the cardioprotective effect of ART wanes away and dyslipidaemia resurfaces with the continued course of the drugs (26). The pathogenesis of ART-related dyslipidaemia is multifactorial. The ART have direct effect on endothelial and adipocyte cell function. This causes the release of proinflammatory cytokines like interleukin-1, interleukin-6, Tumour necrosis factor-α from these sites. These factors inhibit lipoprotein lipase activity, decrease TGL clearance and promote hepatic VLDL production (10).

There are two NRTIs in the drug regimen of patients of present research. The NRTIs cause dyslipidaemia by decreasing transcription of mitochondrial RNA, which causes upregulation of nuclear genes involved in transcriptional regulation of mitochondrial RNA and oxidation of fatty acids (27). Efavirenz, belonging to NNRTI class of drug found here. It is also known to be associated with high plasma lipid levels by mechanism similar to that exerted by NRTIs (28). Nevirapine, another NNRTI found in the present study is associated with a favourable lipoprotein profile, as it increases HDL-cholesterol and apo A1 plasma levels (29). This explains, the high HDL-c levels in ZLN group of the study, as compared to the TLE group.

The evolution of new ART has paved way to substitute dyslipidaemia, causing medications with more lipid friendly drugs. Over the years, Stavudine has been replaced by Zidovudine. Tenofovir, a NtRTI is more lipid compliant as proven by studies (30) and NACO now recommends, Tenofovir based ART regime, as the first line regimen for newly diagnosed HIV patients (31).


The cross-sectional nature of the study, made it difficult to analyse any causality.


The current study validates the prevalence of dyslipidaemia in HIV patients on ART, enrolled at the ART centre of Chamarajanagar. The study also ascertains that lipid abnormalities are more in HIV patients on ZLN drug regimen than those on TLE regimen. The longer course of disease/ART is associated imminent lipoprotein derangement in HIV infected individuals. The ART has increased the lifespan of the individuals living with HIV infections. By doing so, the people living with HIV now involve a good percentage of elderly people, who like rest of the population have age related health issues. Dyslipidaemia, is one among them. HIV infected people have to now confront cardiovascular disease risk not only due to their environmental and genetic predisposition but also due to the viral infection and the therapy to fight the infection. This amplifies the CVD risk manifold in these people. The ART should now be designed to address this challenge. This can be achieved by Institution of novel group of ART, which are more lipid compliant. Likewise regular monitoring of their blood lipid parameters and timely intervention by lipid lowering drugs, will further enhance their health status and promote longevity of these individuals.


Sincere thanks to all the HIV patients, who consented to be a part this research project. Special thanks to the technicians of the Clinical Biochemistry Laboratory, CIMS Teaching Hospital, for helping to process the blood samples of the HIV patients.


Deeks SG, Overbaugh J, Phillips A, Buchbinder S. HIV infection. Nat Rev Dis Primers. 2015;1:15035. [crossref] [PubMed]
Weber J. The pathogenesis of HIV-1 infection. Br Med Bull. 2001;58:61-72. [crossref] [PubMed]
UNAIDS. Global HIV & AIDS statistics-Fact sheet. Source: UNAIDS 2021 epidemiological estimates. Available from: [Date of Access: 19/04/2022].
National AIDS Control Organization Facts and figure 2019. Available from: http:// [Date of Access: 18/08/2021].
Oka F, Naito T, Oike M, Imai R, Saita M, Inui A, et al. Correlation between HIV disease and lipid metabolism in antiretroviral-naïve HIV-infected patients in Japan. J Infect Chemother. 2012;18(1):17-21. [crossref] [PubMed]
Melzi S, Carenzi L, Cossu MV, Passerini S, Capetti A, Rizzardini G. Lipid metabolism and cardiovascular risk in HIV-1 infection and HAART: Present and future problems. Cholesterol. 2010;2010:271504. [crossref] [PubMed]
Giannarelli C, Klein RS, Badimon JJ. Cardiovascular implications of HIV-induced dyslipidemia. Atherosclerosis. 2011;219(2):384-89. [crossref] [PubMed]
Ombeni W. Kamuhabwa AR. Lipid profile in HIV-infected patients using first-line antiretroviral drugs. J Int Association of Providers of AIDS Care. 2016;15(2):164-71. [crossref] [PubMed]
Ceccato MGB, Bonolo PF, Neto S, Araujo FS, Freitas MIF. Antiretroviral therapy-associated dyslipidemia in patients from a reference center in Brazil. Braz J Med Biol Res. 2011;44(11):1177-83. [crossref] [PubMed]
Singh J, Verma M, Ghalaut PS, Verma R, Soni A, Ghalaut VS. Alteration in lipid profile in treatment-naive HIV-infected patients and changes following HAART initiation in Haryana. J Endocrinol Metab. 2014;4(1-2):25-31. [crossref]
Solnica B, Sygitowicz G, Sitkiewicz D, Cybulska B, Józ´ wiak J, Odrowaz- Sypniewska G, et al. 2020 Guidelines of the Polish Society of Laboratory Diagnostics (PSLD) and the Polish Lipid Association (PoLA) on laboratory diagnostics of lipid metabolism disorders. Arch Med Sci. 2020;16(2):237-52. [crossref] [PubMed]
Zhou DT, Kodogo V, Vongai Chokuona KF, Gomo E, Oektedalen O, Stray- Pedersen B. Dyslipidemia and cardiovascular disease risk profiles of patients attending an HIV treatment clinic in Harare, Zimbabwe. HIV/AIDS-Res Palliat Care. 2015;7:145-55. [crossref] [PubMed]
Wafai N, Zafar K, Kumar M, Singh P, Yadav S. Pattern of dyslipidaemia in human immunodeficiency virus infected patients- A study from rural tertiary care hospital in central India. Int J Res Med Sci. 2016;4(10):4349-55. [crossref]
Tadewos A, Addis Z, Ambachew H, Banerjee S. Prevalence of dyslipidemia among HIV-infected patients using first-line highly active antiretroviral therapy in Southern Ethiopia: A cross-sectional comparative group study. AIDS Res Ther. 2012;9(1):31. [crossref] [PubMed]
Dave JA, Levitt NS, Ross IL, Lacerda M, Maartens G, Blom D. Anti-retroviral therapy increases the prevalence of dyslipidemia in South African HIV-infected patients. PLoS One. 2016;11(3):01-13. [crossref] [PubMed]
Gurav N, Ravi K, Sumana B, Rajanna A, Rajalbandi R. A clinical profile of adverse drug reaction in HIV patients on highly active antiretroviral therapy. APIK J Intern Med. 2022;10(1):34-38. [crossref]
Van Leth F, Phanuphak P, Stroes E, Gazzard B, Cahn P, Raffi F, et al. Nevirapine and efavirenz elicit different changes in lipid profiles in antiretroviral-therapy-naive patients infected with HIV-1. PLoS Med. 2004;1(1):64-74. [crossref] [PubMed]
Singla R, Sharma N. A comparative evaluation of the effects of zln and tle anti- retroviral regimens in HIV positive patients: A retrospective record-based study. Indian J Physiol Pharmacol. 2020;64(4):298-02. [crossref]
Mathur MK, Rajput JS. CD4 Change among HIV patients on ART regime, switch over from nevirapine to efavirenz: A comparative study. Int J Contemp Med Res. 2017;4(9):1883-85. [crossref]
Chavan S, Jain K, Honrao S, Padhiyar R. Adverse drug reactions related to highly active antiretroviral therapy in human immunodeficiency virus positive patients-A Prospective study. SAS J Med. 2019;5(9):162-68.
Pandharpurkar D, Krishna G, Mallikarjun P. Clinical and immunological responses of zidovudine lamivudine-nevirapine versus tenofovir lamivudine-efavirenz antiretroviral treatment among HIV-1 infected adults: Gandhi Hospital, Telangana, India. Int J Res Med Sci. 2019;7(6):2177-81. [crossref]
Gallant JE, DeJesus E, Arribas JR, Pozniak AL, Gazzard B, Campo RE, et al. Tenofovir DF, Emtricitabine, and Efavirenz vs. Zidovudine, Lamivudine, and Efavirenz for HIV. N Engl J Med. 2006;354(3):251-60. [crossref] [PubMed]
Kemal A, Teshome MS, Ahmed M, Molla M, Malik T, Mohammed J, et al. Dyslipidemia and associated factors among adult patients on antiretroviral therapy in armed force comprehensive and specialized hospital, Addis Ababa, Ethiopia. HIV AIDS (Auckl). 2020;12:221-31. [crossref] [PubMed]
Rasheed S, Yan JS, Lau A, Chan AS. HIV replication enhances production of free fatty acids, low density lipoproteins and many key proteins involved in lipid metabolism: A proteomics study. PLoS One. 2008;3(8):e3003. [crossref] [PubMed]
Kiage JN, Heimburger DC, Nyirenda CK, Wellons MF, Bagchi S, Chi BH, et al. Cardiometabolic risk factors among HIV patients on antiretroviral therapy. Lipids Health Dis. 2013;12(1):01-09. [crossref] [PubMed]
Riddler SA, Smit E, Cole SR, Li R, Chmiel JS, Dobs A, et al. Impact of HIV infection and HAART on serum lipids in men. J Am Med Association. 2003;289:2978-82. [crossref] [PubMed]
Mallon PWG, Unemori P, Sedwell R, Morey A, Rafferty M, Williams K, et al. In vivo, nucleoside reverse-transcriptase inhibitors alter expression of both mitochondrial and lipid metabolism genes in the absence of depletion of mitochondrial DNA. J Infect Dis. 2005;191(10):1686-96. [crossref] [PubMed]
Sinxadi PZ, McIlleron HM, Dave JA, Smith PJ, Levitt NS, Haas DW, et al. Plasma efavirenz concentrations are associated with lipid and glucose concentrations. Med (United States). 2016;95(2):01-07. [crossref] [PubMed]
Clotet B, van der Valk M, Negredo E, Reiss P. Impact of nevirapine on lipid metabolism. J Acquir Immune Defic Syndr. 2003;34 (Suppl 1):S79-84. [crossref] [PubMed]
Dubé MP. Dyslipidemia in HIV. Lipid Manag from Basics to Clin. 2015;72(12):241-55. [crossref]
Chauhan NS, Shah SP, Desai MK, Shah A. A safety analysis of different drug regimens used in human immunodeficiency virus-positive patients. Indian Journal of Sexually Transmitted Diseases and AIDS. 2018;39(2):84-90. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/60089.17218

Date of Submission: Sep 07, 2022
Date of Peer Review: Sep 30, 2022
Date of Acceptance: Nov 11, 2022
Date of Publishing: Dec 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Sep 09, 2022
• Manual Googling: Oct 26, 2022
• iThenticate Software: Nov 01, 2022 (11%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)