Protease inhibitor-based HAART, HDL, and CHD-risk in HIV-infected patients

• Published in: Atherosclerosis Vol. 184; no. 1; pp. 72 - 77
• Main Authors: Asztalos, Bela F., Schaefer, Ernst J., Horvath, Katalin V., Cox, Caitlin E., Skinner, Sally, Gerrior, Jul, Gorbach, Sherwood L., Wanke, Christine
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ireland Ltd 2006; Elsevier
• Subjects: Adult; Antiretroviral Therapy, Highly Active - methods; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Biomarkers - blood; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular system; CHD-risk; Cholesterol, HDL - blood; Cholesterol, LDL - blood; Coronary Disease - blood; Coronary Disease - complications; Coronary heart disease; Disease Progression; Female; HAART; HDL particles; Heart; HIV - immunology; HIV Antibodies - immunology; HIV Infections - blood; HIV Infections - complications; HIV Infections - drug therapy; HIV-infection; Humans; Lipoproteins; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Protease Inhibitors - adverse effects; Protease Inhibitors - therapeutic use; Risk Factors; Treatment Outcome; Triglycerides - blood; Vasodilator agents. Cerebral vasodilators; Lipoproteins; HDL particles; HIV-infection; CHD-risk; HAART; Lipids; Metalloendopeptidases; Cardiovascular disease; Vascular disease; Lipoprotein LDL; Particle; Pitrilysin; Cholesterol HDL; Atherosclerosis; Lipoprotein HDL; Human; Immunopathology; Enzyme; Cholesterol LDL; AIDS; Triglyceride; Immune deficiency; Coronary heart disease; Infection; Peptidases; Treatment; Viral disease; Risk factor; Hydrolases; Protease inhibitor
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2005.04.013

To study the effects of HIV-infection and protease inhibitor (PI)-based highly active anti-retroviral therapy (HAART) on the lipid and high-density lipoprotein (HDL) subpopulation profile and to relate the changes to coronary heart disease (CHD)-risk.
The lipid and HDL subpopulation profiles of HIV-positive subjects (
n
=
48) were studied prospectively by comparing pre- and post-PI-HAART data as well as cross-section by comparing the profiles to HIV-negative subjects with (
n
=
96) and without CHD (
n
=
96).
HIV-infected HAART-naïve subjects had lower concentrations of low-density lipoprotein cholesterol (LDL-C) and HDL-C and higher concentration of triglycerides (TG) than healthy controls. After receiving PI-based HAART, LDL-C and TG concentrations increased, while HDL-C concentrations remained unchanged. The HDL subpopulation profiles of HAART-naïve HIV-positive patients were significantly different from those of healthy controls and were similar to those with CHD. Moreover, the HDL subpopulation profile changed unfavorably after PI-based HAART, marked with increased concentrations of the small, lipid-poor pre-β-1 HDL (32% or 3.9
mg/dl;
p
<
0.001), and decreased concentration of the large, cholesterol-rich α-1
HDL(9% or 1
mg/dl
ns).
An already unfavorable lipid and HDL subpopulation profile of HIV-positive HAART-naïve subjects further deteriorated after receiving PI-based treatment, which may cause increased CHD-risk in these subjects.