Protease inhibitor related type III hyperlipoproteinaemia is common and not associated with apolipoprotein-E E2/E2 phenotype

Objective: To determine the prevalence of type III hyperlipoproteinaemia in a cohort of HIV infected patients taking protease inhibitor and its correl ation with the apolipoprotein-E2 isoform. Design: Cross sectional study of 57 consecutive HIV infected subjects takin g protease inhibitor therapy for a median of 12.5 (1-29) months, seen in an outpatient HIV clinic. Controls were 17 patients on non-nucleoside reverse transcriptor inhibitor therapy (NNRTI) for 9 (1-19) months and 50 antiviri al naive patients. Methods: Fasting cholesterol, triglyceride, HDL cholesterol, lipoprotein (a ), and glucose were measured. Lipoprotein elecctrophoresis was performed on patients with a cholesterol >6.5 mmol/l and a triglyceride concentration o f >4.5 mmol/l. Apolipoprotein-E phenotype was determined in serum. Results: Dyslipidaemia was found in 43 (75%) PI treated patients-37 with tr iglyceride >2.3 mmol/l, 30 with cholesterol >6.5 mmol/l, and nine with HDL cholesterol <0.9 mmol/l. 38% had a lipoprotein (a) > 300 mg/l. 11 patients (19.3%) had a type III hyperlipoproteinaemia pattern. Only one was homozygo us for the E2 phenotype and none had clinical diabetes. An additional patie nt had a serum lipid profile compatible with type III hyperlipoproteinaemia and an E3/E2 phenotype in whom electrophoresis was not carried out before treatment. Six (35%) of the NNRTI and 16 (32%) of the antiviral naive patie nts had dyslipidaemia. 18 (31.6%) of the PI and none of the control patient s had a cholesterol and/or triglyceride >8 mmol/l. Conclusion: Type III hyperlipoproteinaemia is common in this group of patie nts and need not be associated with the apolipoprotine-E2/E2 isoform. HIV p rotease inhibitors may interfere with lipoprotein receptor related protein.