Dynamics of total lipid parameters related to constitutional syndrome in patients with HIV-associated tuberculosis

Abstract. Introduction. Lipid imbalance is an important pathogenetic element in the development of constitutional syndrome at late stages of HIV infection. Studying the dynamics of total lipid fractions is a prerequisite for expanding the diagnostic potential of and for a more detailed understanding the pathogenesis of this condition. Aim. To evaluate the dynamics of total lipid fractions in HIV/tuberculosis patients in stages 4A-B with decreased body weight, with and without antiretroviral therapy. Materials and Methods. Total lipid fractions were studied by one-dimensional flow chromatography in 100 patients with HIV-associated tuberculosis who received antituberculosis chemotherapy and in 100 patients with HIV/tuberculosis who received antiretroviral therapy on the background of antituberculosis therapy for 2 months. The control group consisted of 50 healthy individuals. All patients underwent the immunophenotyping of CD4-lymphocytes with determination of absolute and relative numbers of and HIV RNA viral load. The data were statistically analyzed using parametric statistical methods. Results and Discussion. The levels of free fatty acids and total cholesterol before treatment were higher and those of triglycerides lower in both groups of patients compared to the group of healthy individuals (p<0.001). After one month of antiretroviral therapy against the background of antituberculosis treatment in group 2, positive shifts were noted in the form of triglycerides increase and total cholesterol decrease to the level of healthy individuals (p<0.001), free fatty acids level decrease (p<0.05) against the values before treatment. Against the background of triglycerides level normalization with simultaneous reduction of free fatty acids, there was a significant decrease in the number of patients with constitutional syndrome manifestations (from 66/66% down to 37/37%, p<0.001). In group 1 receiving antituberculosis therapy only, there were no such changes: The levels of triglycerides, total cholesterol and free fatty acids did not change significantly compared to the beginning of therapy and to the control group (p>0.05). Conclusions. In the group of patients receiving antiretroviral and antituberculosis therapy, the disturbed ratio of total lipid fractions was restored. A relative decrease in the levels of free fatty acids and a simultaneous increase in triglyceride levels compared to the same of healthy individuals against the background of antiretroviral therapy contributed to the decrease in the number of patients with constitutional syndrome.