This primarily and large study of HIV infected subject on ART found that dyslipidemia was a high predominant disorder. Majority of the subjects (60%) had increased levels of TG or TC while a less proportions of subject affected with high levels of LDL (35.1%) and FPG (38.2%) and, low HDL level (28.7%). Some studies in Thailand reported a similar rate of dyslipidemia at 53.6% and 88% [38, 50]. Other studies from other developing countries showed similar results oh high prevalence lipid abnormalities rate of more than 76%  from Tanzania, 82.3%  from Southern Ethiopia, 20-100% from India [7, 41].
Disturbances in level of triglyceride and total cholesterol were more prevalent than HDL and LDL in this study. Generally increases in TG and TC level are mainly attributed to treatment with PIs. The multiple mechanism of PIs in developing lipid and glucose abnormalities include reduction in catabolism and increase in production of very low density lipoprotein [51, 52], impaired catabolism of fatty free acid , increased synthesis of triglyceride in liver , decreased expression of LDL receptors , interference with the intercellular process regulating glucose and lipid metabolism in insulin-response tissue . Other relevant factors comprise of aging, abdominal obesity, diabetes, lifestyle, gender and ethnic differences, type and length of time on ARV regimen can result in various incidence/prevalence of lipid and glucose abnormalities.
Aging, race and gender differences are well-known irreversible risk factors for metabolic abnormalities. Elderly population has lipid and glucose metabolism changes due to liver cell dysfunctions . The beneficial effect of endogenous estrogen women before menopause causes less lipid abnormalities . Similar to this study Richter and colleagues  in a cohort study indicated that age, treatment with PI and male gender were risks for dyslipidemia. Some studies [60, 61] which were conducted in the United State also revealed that race/ethnicity was a highly significant predictor of plasma lipids. In a study the increased lipid level was significantly less associated with Malay and Chinese’s race . One of the possible explanations may be due to the lower prevalence of abdominal obesity among Malay and Chinese HIV patients . In the present study alcohol consumption was associated with high level of TG. As the recognized dietary risk for high TG, alcohol is rich in calorie and disturb the liver function, the human organ which contributes in metabolize of the nutrients , thus it can be stored in body as fat and increase in blood as TG. It is important to stress that the data are derived from a male population mostly and that their relevance is mainly to be referred to male sex.
Interestingly the effect of some risk or protective factors on lipid and glucose can be explained by their indirect and intermediary role. In this study higher CD4 cell count was a risk factor for high TG while viral load level < 20 (copies/mm3) raised the risk of high TC. ARV medications boost immune system by increasing in CD4 cells and diminishing HIV vial load thus the effect of ARV medication on lipids was seen through the raised CD4 and decreased viral load . We also found that treatment with anti-hyperglycemic agents was a significant associated risk for high TG and low HDL level. Since diabetic patients have more lipid abnormalities thus taking anti-hyperglycaemic medication can make a connection between diabetes and these lipid disorders indirectly . Approximately 14% of our population had hepatitis as liver diseases who had lowered risk of lipid disorders and increased possibility of high FPG. On the hepatitis virus nature, some studies found that hepatitis viral replication during its metabolic processes can drop in lipid levels by interrupting cholesterol synthesis and using host lipids for replication, decreasing circulating lipids, and clearance of the virus results in rebound increase of lipid levels [66, 67]. Since liver is the main body organ for balancing plasma glucose, damage to the liver cell by hepatitis virus causes disturbed liver function and insulin production  thus it is expected the elevated FPG during hepatitis infection.
Limitations of the study
Comprehensive blood lipid and glucose evaluation were not assessed in this study just for those with current tests (year 2012). Also inability of assessment of anthropometrics including waist circumference, body mass index (BMI) and body fat percentage, the cross-sectional nature of the study, small number of female as well Indian subjects, and lack of ARVnaïve or HIV negative subjects as controls, absence of previous published studies in lipid abnormalities among Malaysian population with HIV/AIDS in order to comparison with the present study were considered as other limitations in this study.