Sex differences in HAART-associated dyslipidaemia

Objectives: Because female sex protects against dyslipidaemia and atheroscl erosis in normal subjects, we aimed to reveal potential sex differences in metabolic side-effects of a newly initiated highly active antiretroviral th erapy (HAART) regimen, and to relate these changes to endothelial cell acti vation as measured by levels of circulating E selectin (cE-selectin). Design: Prospective longitudinal cohort study. Setting: Tertiary care centre at a University Hospital. Methods: HIV-seropositive male (n = 27) and female patients (n = 13)with a plasma viral load of greater than or equal to 10 000 copies/ml and 35 healt hy controls were enrolled in the study. All participants were weight stable , free of acute opportunistic infections, and had not taken any protease in hibitors before. Serum levels of lipids, insulin, leptin, and cE-selectin w ere measured before initiation of HAART, and at 3 and 6 months thereafter. Results: HAART increased serum levels of triglycerides, leptin, and low-den sity lipoprotein (LDL) cholesterol; these effects were more distinct in wom en. Fasting insulin levels and the LDL:high density lipoprotein (HDL) ratio increased only in female HIV-infected patients (P<0.02 versus men). In con trast, endothelial activation, as measured by cE-selectin, decreased more i n men (P< 0.02) than in women. As a consequence, women had higher triglycer ides and leptin levels after therapy than did men, and the LDL:HDL ratio an d cE-selectin levels, which were initially higher in men, were no longer di fferent between the sexes. Conclusions: Metabolic adverse effects during HAART are more pronounced in women than in men. Hence, female HIV-infected patients seem to loose part o f their natural protection from atherosclerosis during antiretroviral thera py. (C) 2001 Lippincott Williams & Wilkins.