{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,9,25]],"date-time":"2023-09-25T10:12:15Z","timestamp":1695636735646},"reference-count":28,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2017,3,23]],"date-time":"2017-03-23T00:00:00Z","timestamp":1490227200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["674\u2010A\u201000\u201009\u201000018\u201000","674\u2010A\u201000\u201002\u201000018","674\u2010A\u201000\u201008\u20100000\u2010700","674\u2010A\u201012\u201000029"],"award-info":[{"award-number":["674\u2010A\u201000\u201009\u201000018\u201000","674\u2010A\u201000\u201002\u201000018","674\u2010A\u201000\u201008\u20100000\u2010700","674\u2010A\u201012\u201000029"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Antiretroviral therapy (<jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content>) has been associated with unfavourable lipid profile changes and increased risk of cardiovascular disease (<jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>). With a growing population on <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> in South Africa, there has been concern about the increase in noncommunicable diseases such as <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>. We determined risk factors associated with increased total cholesterol (<jats:styled-content style=\"fixed-case\">TC<\/jats:styled-content>) in a large cohort on <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> and describe the clinical management thereof.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted an observational cohort study of <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content>\u2010na\u00efve adults initiating standard first\u2010line <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> in a large urban clinic in Johannesburg, South Africa. <jats:styled-content style=\"fixed-case\">TC<\/jats:styled-content> was measured annually for most patients. A proportional hazards regression model was used to determine risk factors associated with incident high <jats:styled-content style=\"fixed-case\">TC<\/jats:styled-content> (\u2265 6 mmol\/L).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Significant risk factors included initial regimen non\u2010tenofovir <jats:italic>vs<\/jats:italic>. tenofovir [hazard ratio (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>) 1.54; 95% confidence interval (<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>) 1.14\u20132.08], age \u226540 <jats:italic>vs<\/jats:italic>. &lt;30 years (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 3.22; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 2.07\u20134.99), body mass index (<jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content>) \u2265 30 kg\/m<jats:sup>2<\/jats:sup> (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 1.65; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.18\u20132.31) and <jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content> 25\u201329.9 kg\/m<jats:sup>2<\/jats:sup> (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 1.70; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.30\u20132.23) <jats:italic>vs<\/jats:italic>. 18\u201324.9 kg\/m<jats:sup>2<\/jats:sup>, and baseline <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4 count &lt; 50 cells\/\u03bcL (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 1.55; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.10\u20132.20) and 50\u201399 cells\/\u03bcL (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 1.40; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.00\u20131.97) <jats:italic>vs<\/jats:italic>. &gt; 200 cells\/\u03bcL. Two\u2010thirds of patients with high <jats:styled-content style=\"fixed-case\">TC<\/jats:styled-content> were given cholesterol\u2010lowering drugs, after repeat <jats:styled-content style=\"fixed-case\">TC<\/jats:styled-content> measurements about 12 months apart, while 31.8% were likely to have received dietary counselling only.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Older age, higher <jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content>, lower <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4 count and a non\u2010tenofovir regimen were risk factors for incident elevated <jats:styled-content style=\"fixed-case\">TC<\/jats:styled-content>. Current guidelines do not indicate regular cholesterol testing at <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> clinic visits, which are the main exposure to regular clinical monitoring for most <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u2010positive individuals. If regular cholesterol monitoring is conducted, improvements can be made to identify and treat patients sooner.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.12495","type":"journal-article","created":{"date-parts":[[2017,3,24]],"date-time":"2017-03-24T04:59:08Z","timestamp":1490331548000},"page":"595-603","source":"Crossref","is-referenced-by-count":5,"title":["Changes in elevated cholesterol in the era of tenofovir in South Africa: risk factors, clinical management and outcomes"],"prefix":"10.1111","volume":"18","author":[{"given":"L","family":"Jamieson","sequence":"first","affiliation":[{"name":"Health Economics and Epidemiology Research Office Department of Internal Medicine School of Clinical Medicine Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D","family":"Evans","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office Department of 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