Serum lipid levels associated with increased risk for cardiovascular disease is associated with highly active antiretroviral therapy (HAART) in HIV-1infection
K. Koppel et al., Serum lipid levels associated with increased risk for cardiovascular disease is associated with highly active antiretroviral therapy (HAART) in HIV-1infection, INT J STD A, 11(7), 2000, pp. 451-455
The long-term effects of fat metabolism, storage and utilization in HIV-1 i
nfected patients on highly active antiretroviral therapy (HAART) including
a protease inhibitor are profound and cause increasing concern. The main im
portance of these lipid/metabolic disorders lies in their assumed contribut
ion to an increased risk of coronary heart disease (CHD). In the general po
pulation increased levels of lipoprotein(a) [Lp(a)] constitute an independe
nt risk factor for CHD by itself as well as in combination with increased l
evels of cholesterol and low density lipoprotein (LDL)-cholesterol, respect
ively.
Two hundred and fifty-six patients with 27+/-7 months HAART and 84 treatmen
t-naive HIV-1 positive patients were screened for cardiovascular risk facto
rs. The subjective perception of fat wasting and/or accumulation in differe
nt sites of the body, which was possible to evaluate in 235 patients on HAA
RT and 73 treatment-naive patients, the levels of plasma triglycerides (TG)
, cholesterol, LDL and high-density lipoproteins (HDL)-cholesterol, LDL/HDL
ratio and Lp(a) were measured.
Of the patients on HAART, 42% (98/235) reported abnormal fat distribution a
s compared with 4% (3/73) of the treatment-naive patients (P < 0.0001). The
levels of TG, cholesterol and LDL-cholesterol, but not HDL-cholesterol or
Lp(a) were higher (P<0.0001) in the HAART group as compared with the naive
group. Very high Lp(a) levels (> 700 mg/l) were more common among HAART pat
ients as compared with naive, 14% (36/256) vs 2% (2/83); P=0.0022. The Lp(a
) levels correlated to the levels of LDL-cholesterol, but not to total chol
esterol, HDL-cholesterol or TG, and did not differ between patients with an
d without subjective perception of abnormal fat distribution.
A significant number of the HAART patients had very high levels of Lp(a) an
d various combinations of increased lipid values associated with considerab
ly increased risk for CHD. The elevation of Lp(a) did not relate to any oth
er clinical or laboratory parameter than to LDL-cholesterol.