Antiretroviral therapy in HIV‐positive men is associated with increased apolipoprotein CIII in triglyceride‐rich lipoproteins

• Published in: HIV medicine Vol. 6; no. 5; pp. 326 - 333
• Main Authors: Rimland, D, Guest, JL, Hernández, I, Del Rio, C, Le, NA, Brown, WV
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01-09-2005
• Subjects: Adult; Aged; Aged, 80 and over; Anti-HIV Agents - adverse effects; Anti-HIV Agents - therapeutic use; Apolipoprotein C-III; Apolipoproteins C - blood; Cross-Sectional Studies; Dyslipidemias - blood; Dyslipidemias - chemically induced; HIV; HIV Infections - blood; HIV Infections - drug therapy; HIV Protease Inhibitors - adverse effects; HIV Protease Inhibitors - therapeutic use; Humans; lipoproteins; Male; Middle Aged; Reverse Transcriptase Inhibitors - adverse effects; Reverse Transcriptase Inhibitors - therapeutic use; triglycerides; Triglycerides - blood
• ISSN: 1464-2662; 1468-1293
• DOI: 10.1111/j.1468-1293.2005.00316.x

Objectives
Dyslipidaemia has become a common problem in HIV disease, especially in patients on current antiretroviral therapy. However, the pathogenic mechanisms involved are not well understood or documented using conventional lipid measurements.
Methods
Using a cross‐sectional design, the prevalence of abnormal standard lipid measurements and novel biomarkers for abnormal lipid metabolism was determined in 271 HIV‐positive men from two HIV clinics in Atlanta, GA, USA.
Results
A total of 147 men were treated with protease inhibitors (PIs) for >3 months (54%), 84 were treated with nonnucleoside reverse transcriptase inhibitors (NNRTIs) for >3 months (31%) and 40 had not received antiretroviral therapy in the past 3 months (15%). Patients being treated with a PI had higher total cholesterol and triglyceride (TG) levels than patients on no therapy (P<0.05 for each). Patients in the NNRTI group had higher TG, lower high‐density lipoprotein (HDL) levels, and higher low‐density lipoprotein (LDL) levels than patients on no therapy (P<0.05 for each). Patients treated with either PIs or NNRTIs were more likely to have higher apolipoprotein CIII (apoCIII) levels (P<0.05 for each) than patients on no therapy. Elevated TG was associated with disproportionably elevated apoCIII levels in both treatment groups.
Conclusions
In this cross‐sectional study of HIV‐infected men, either PI or NNRTI therapy elevated levels of TG and apoCIII. Higher concentrations of apoCIII in apoB‐containing lipoproteins [very low‐density lipoproteins (VLDLs), intermediate density lipoprotein (IDL) and LDLs] have been predictive of an increased incidence of coronary events in clinical trials and more rapid progression of coronary lesions measured by angiography. These findings, on a background of an older population with additional risk factors of smoking and diabetes, portend future atherosclerotic events in these patients.