Background: Mortality from AIDS has been reduced with the availability of HIV-protease inhibitors (PI); however, lipid abnormalities have become common among PI-treated patients (pts) that may lead to premature atherosclerosis and its complications. The pathogenesis of these abnormalities is not well understood. We studied the prevalence of lipid abnormalities and apolipoproteins (new markers of coronary artery disease) among HIV-infected women in an inner city clinic in the U.S.

Methods: Cross-sectional study of HIV-infected women who had: 1) ≥ 3 months (mos) of stable ARV therapy; 2) no ARV therapy in the last 3 mos; or 3) who were treatment naïve. A survey and a complete fasting lipid profile were performed. Laboratory and medical records were reviewed. Comparisons were made using Chi-Square, Fisher’s Exact test or t test as appropriate.

Results: A total 202 HIV-infected women were included between 3/02 and 10/02. The majority were African American (90%), with median age of 41 yrs (range 21–72); 8% were diabetic, 42% smoked, 10% were on anti-lipid drugs, and 67% were overweight. Mean CD4 count was 371 cells/µL (median 323, range 11–1,123) and mean viral load was 61,153 copies/mL (median 1,070, range 30– >750,000). Half of the pts had a viral load <10,000 but ≥ 50 copies/mL. Two-thirds (134/202) had received ARVs for at least 3 mos, 25% (50) had no ARV therapy in the last 3 mos, and 9% (18) were naïve. Among those receiving ARVs (134), 65% (86) were on a PI (NFV 55%, LPV/rtv 30%, IDV 12%, RTV 8%) and 35% were on an NNRTI together with reverse transcriptase inhibitors (d4T in 30% and ddI in 26%).

Percentage of patients with lipid abnormalities. Comparisons by group.

Group	n	Chol ≥ 240	TG ≥ 200	HDL ≤ 35	LDL ≥ 160	ApoB ≥ 120	ApoC-III > 25	ApoE < 4
Overall	202	13.0	16.8	22.3	9.4	25.7	30.2	13.4
PI	86	20.9	18.6	11.6	16.3	34.9	41.9	3.5
vs NoPI	48	12.5	18.7	14.6	2.1 *	27.1	33.3	16.7 *
vs No ARV/ naïve	68	2.9 †	13.4	41.2 ‡	5.9 *	13.2 †	13.2 ‡	23.5†
PI with hyperlipidemia	26	69.2	61.5	7.7	42.3	61.5	80.8	0.0
vs PI with normal lipids	60	0.0 ‡	0.0 ‡	13.3	5.0 ‡	23.3 †	25.0 ‡	5.0

* p < 0.05  † p ≤ 0.01  ‡ p ≤ 0.0001

Conclusions: Our data suggest that among PI-treated women, lipid abnormalities seem to be related to excess production of ApoC-III, which can interfere with normal triglyceride hydrolysis. Detailed apolipoprotein composition analysis would support the preferred conversion of these triglyceride-rich lipoproteins to the atherogenic LDL.