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Session 100 Poster Abstracts
Dyslipidemias and Body Fat Abnormalities: Incidence, Risk Factors, Response to Therapy
Monday, 1:30 - 3:30 pm
Poster Hall


712    
Predictors of Low HDL in HIV+ Patients: Effect of Class of Antiretroviral Therapy and Traditional Risk Factors (CPCRA 065)
F Drummond*1, C Mullin2, M Poehlman2, and SMART Protocol Team and the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA 065)
1Univ. of New South Wales, Sydney, Australia and 2Univ. of Minnesota, Minneapolis, USA

Background:  Low HDL cholesterol levels are associated with an increased risk of cardiovascular disease (CVD) in HIV- populations. The objective of this analysis was to investigate the predictors of low HDL cholesterol in HIV+ populations.

Methods:  Patients in this analysis were enrolled in the Strategies for Management of AntiRetroviral Therapy (SMART) Study; an ongoing randomized, controlled clinical trial comparing episodic antiretroviral treatment (ART) with continuous viral suppression.  In cross-sectional analysis, factors associated with low HDL (<40 mg/dL) cholesterol were explored using logistic regression models. Co-variates considered include age, gender, smoking status, body mass index, race, history of diabetes, use of blood pressure medication, triglycerides, classes of ART currently prescribed, and HIV RNA.

Results:  Data are from the 1028 patients with baseline results available at the time of analysis, 44.5% of whom had low HDL. The probability of low HDL was higher among patients not on ART (n = 205) than those who were on ART (n = 823) (OR = 0.35, p <0.001). For patients not on ART, a higher log viral load was associated with an increased probability of lower HDL (OR = 1.63, p <0.01).  Among patients on ART, the probability of low HDL was lower for patients taking NNRTI (n = 363) than those taking other ART classes (n = 460) (OR = 0.51 p <0.01).  The effects of traditional risk factors for low HDL (race, gender, smoking, body mass index >30, triglycerides >200 mg/dL, diabetes, and use of blood pressure medication) were relatively consistent across different ART classes.  Patients who were off ART and had 3 or more traditional risk factors had the highest risk of low HDL (71%), while those on NNRTI and who had less than 3 risk factors had the lowest risk of low HDL (16%). Overall, 53.7% of patients had 3 or more of the traditional risk factors for low HDL.

Conclusions:  Both ART and traditional cardiovascular risk factors affect HDL cholesterol levels in HIV+ populations; these effects appear to be additive in nature. Whether the higher HDL levels associated with ART use are surrogates for decreased CVD risk is unknown and will ultimately be addressed in the long-term follow-up of trials such as the SMART study.

Keywords: HDL cholesterol; antiretroviral therapy; risk factors