Background:  Dyslipidemia has been associated with ART and chronic HIV infection. We evaluated the prevalence of dyslipidemia in the Fat Redistribution and Metabolic Change (FRAM) cohort and identified HIV- and sex-specific host risk factors.

Methods:  FRAM is a cross-sectional study of HIV⁺ patients in the United States. Whole-body magnetic resonance imaging (MRI), anthropometrics, and fasting triglycerides (TG), total cholesterol (TC), LDL (direct), and HDL were performed. Factors significantly associated with abnormal lipids were identified using multivariable linear regression.

Results:  We enrolled 425 men (241 Caucasian, 130 African American [AA], 353 on ART) and 183 women (59 Caucasian, 102 AA, 131 on ART). Among men, 23% had a TG >400 mg/dL or on therapy for ­ TG, 21% had LDL >160 mg/dL or on therapy for ­ LDL, and 39% had HDL <35 mg/dL or on fibrate or niacin. Independent risks for higher TG levels were ­ visceral adipose tissue, ¯ leg subcutaneous adipose tissue, AIDS diagnosis, ­ CD4 and use of abacavir (ABC), stavudine (d4T), or full-dose ritonavir (RTV). AA race was associated with ¯ TG. For LDL, alcohol use and ­ CD4 were associated with higher levels, while ­ HIV viral load, dideoxycytidine (ddC), and being Hispanic were with lower levels. HDL decreased with ­ visceral adipose tissue, ­ HIV viral load and indinavir (IDV) but increased with AA race, efavirenz (EFV), nevirapine (NVP), and alcohol use. Among women:  10% had a TG >400 mg/dL or on therapy for ­ TG, 19% had LDL >160 mg/dL or on therapy for ­ LDL, and 15% had HDL <35 mg/dL or on fibrate or niacin. Higher TG levels were associated with ­ visceral adipose tissue, ¯ leg subcutaneous adipose tissue, ­ upper trunk fat, ­ CD4, ­ HIV viral load, protease inhibitor (PI) use, EFV and tenofovir (TDF). AA race, alcohol use, and delavirdine (DLV) were associated with ¯ TG levels. For LDL, ¯ HIV viral load, and ­ leg subcutaneous adipose tissue were associated with higher levels, while ­ upper trunk fat, TDF and smoking with lower levels. HDL decreased with ­ visceral adipose tissue, ­ HIV viral load, and TDF, but was higher with NVP and alcohol use.

Conclusions:  HIV-specific and host factors were associated with atherogenic lipid parameters in both men and women. Higher visceral adipose tissue, lower subcutaneous adipose tissue and, for women, greater upper trunk fat, were associated with ­ TG. HIV⁺ Caucasians of both sexes were more likely to have atherogenic lipid profiles than HIV⁺ AA.