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Session 90 Poster Session Incidence, Prevalence, and Pathogenic Correlates of Insulin Resistance and Lipodystrophy Syndrome Session Time: 4:30-6:30 pm Room 4E-F

689-T. Differentiating Hypercholesterolemia Associated with Antiretroviral Therapy (ART) S. Mauss*1, J. Stechel2, R. Willers3, G. Schmutz1, and W. Richter4 1Ctr. for HIV and Hepatogastroenterology, Düsseldorf; 2Cologne; 3Computer Ctr., Univ., Düsseldorf; and 4Res. Inst. for Lipid Metabolism, Windach, Germany Background: Hypercholesterolemia frequently associated with ART led to concerns about an increased cardiovascular risk in treated HIV+ patients. As hypercholesterolemia is caused either by elevated LDL, HDL, or VLDL, we evaluated the lipoprotein pattern in patients with or without ART to estimate cardiovascular risk. Methods: Fasting serum samples were drawn from 187 consecutive HIV+ patients. Total, LDL and HDL cholesterol, triglycerides, and apolipoproteins (apo) A-I and B were determined in serum. VLDL were prepared by ultracentrifugation and analysed for cholesterol, triglyceride and apo B. Results: 32/187 patients (17%) were ART-naïve, 20 (11%) received NRTIs only, 68 (36%) an NNRTI and 64 (34%) a PI containing regimen. 85/187 (45%) had hypercholesterolemia (>200 mg/dL). Of these 12/85 (14%) had hypercholesterolemia due to high LDL, 14 (16%) due to high LDL and VLDL, 56 (66%) due to VLDL and 3 (4%) due to high HDL. PI therapy resulted in higher total, LDL, HDL cholesterol, and triglycerides compared to ART-naïve patients. NNRTI therapy led to higher total, LDL and HDL cholesterol. NRTIs were associated only with higher HDL. In a multivariate analysis higher cholesterol was associated with RTV (p=0.002), age>40 years (p=0.004), EFV (p=0.007) and IDV (p=0.03). Higher LDL cholesterol was associated with FTV (p=0.02), IDV (p=0.02) and EFV (p=0.04). For hypertriglyceridemia no specific risk factor was identified. VLDL composition was analysed in 28 patients with hypercholesterolemia due to high VLDL. The VLDL triglyceride/apo B ratio was 16.1±6.1 showing a prevalence of large triglyceride-rich VLDL particles. Conclusions: Only one third of patients with hypercholesterolemia had high LDL cholesterol (prevalence comparable to normal population). The most common cause for hypercholesterolemia in HIV+ patients under ART was high VLDL. The analysis of the VLDL composition in these patients revealed large triglyceride-rich VLDL particles resembling rather familial hypertriglyceridemia with low coronary risk than familial combined hyperlipidemia with high risk. This indicates that a large subgroup of pts with hypercholesterolemia under ART may have a lower cardiovascular risk than generally expected.

©2002 9th Conference on Retroviruses and Opportunistic Infections