Background: Dyslipidemia has become a common problem in HIV disease, especially in patients (pts) on current antiretroviral (ARV) therapy. The pathogenic mechanisms involved are not well-understood or documented using conventional lipid measurements. ApoCIII, a new biomarker of lipid metabolism, is postulated to produce elevated triglycerides (TG).

Methods: The prevalence of abnormal standard lipid measurements and novel biomarkers for abnormal lipid metabolism was determined in 271 HIV⁺ men from 2 HIV clinics in Atlanta.

Results: A total 147 were treated with protease inhibitors (PI) for > 3 months (mos) (54%), 84 with non-nucleoside reverse transcriptase inhibitors (NNRTI) for > 3 mos (31%), and 40 had not received ARVs in the past 3 mos (15%). Most patients (pts) were African American (56%), > 40 yrs of age (66%), had CD4⁺ counts > 200 cells/mm³ (76%), and had viral loads < 10,000 copies/mL (72%). Forty-one percent (41%) of the pts smoke and 10% have diabetes. Twelve percent (12%) were on lipid-lowering agents with all but 1 being treated with a PI or a NNRTI. There were statistically significant differences in lipid levels in the 3 groups. Pts being treated with a PI were 21% more likely to have elevated total cholesterol and TG levels (Relative risk = 1.21, 95% confidence interval = 1.05–1.39, for each). Pts in the NNRTI group were 31% more likely to have elevated TG, have low HDL levels, and have high LDL levels (p < 0.05, for each). Pts treated with either PIs or NNRTIs were more likely to have higher apoCIII levels (p < 0.05, for each) than pts on no therapy. Elevated TG was associated with elevated apoCIII levels in both treatment groups. There was no difference in apoB and apoE levels among the 3 groups.

 

Percent with Lipid Abnormality by ARV treatment group

Group	N	Chol ≥ 240	TG ≥ 200	HDL ≤ 35	LDL ≥ 160	ApoB ≥ 120	ApoCIII > 25	ApoE < 4
Overall	271	13.3	34.0	44.3	15.6	42.8	24.7	12.9
PI	147	17.0*	37.4*	46.3	14.5	45.4	26.5*	13.6
NNRTI	84	10.7	35.7*	35.7*	21.4*	40.6	27.4*	11.9
No ARV therapy in last 3 months	40	5.0	17.5	55.0	7.5	37.0	12.5	12.5

*p < 0.05; all comparisons made for PI/NNRTI vs “no ARV” group

 

Conclusions: In this cross-sectional study of HIV⁺ men either PI or NNRTI therapy was associated with elevated levels of triglycerides and apoCIII. These findings suggest impaired metabolism of triglyceride-rich lipoproteins and, on a background of an older population with additional risk factors of smoking and diabetes, portend future atherosclerotic events in these pts.