Background:  Differences in responses to lipid lowering therapy (LLT) by HIV status and HAART class are largely unknown.

Methods:  In Kaiser Permanente Northern California, we identified HIV⁺ and HIV^- patients treated with LLT from 1996 to 2005 in 3 cohorts defined by dyslipidemia type:  total cholesterol (TC) ≥240 mg/dL; LDL ≥160 mg/dL or ≥130 if ≥2 coronary heart disease (CHD) risk factors or ≥100 if CHD; and triglycerides (TG) ≥500 mg/dL. HIV⁺ patients aged ≥18 years and age-, sex-, and year-matched HIV^- patients were included. Exclusions were prior dyslipidemia dialysis and prior LLT. Cohorts were not mutually exclusive.  In each cohort, we estimated adjusted percentage of changes in lipids by HIV status 1 year after LLT start using linear regression controlling for sex, age, baseline lipid levels, year, prior CHD/diabetes/hepatitis dialysis, CHD risk factors, and LLT class and duration. Among HIV⁺ patients, we estimated adjusted percentage changes in lipids by HAART class with additional adjustments for baseline CD4, HIV RNA, and AIDS. Adjusted odds ratios (OR) for achieving Adult Treatment Panel III (ATP III) lipid goals were estimated using logistic regression controlling for the same factors.

Results:  Cohorts included 6862 patients (907 HIV⁺) with high TC, 6496 patients (695 HIV⁺) with high LDL, and 5182 patients (511 HIV⁺) with high TG. The most common LLT were statins:  87%, 89%, and 52% in the 3 cohorts, respectively. Of note, dosing of individual LLT was similar by HIV status, but drugs used differed (eg, HIV⁺ patients had more pravastatin use, p <0.001 for all 3 cohorts). HIV⁺ patients had significantly smaller declines in TC, LDL, and TG compared to HIV^- patients (see the table), although differences in percentage change between HIV⁺ and HIV^- patients were larger for TC (4.4%) and TG (17.4%) than for LDL (1.8%).  HIV⁺ patients on PI+NNRTI had the smallest declines in TC and TG compared to other HIV⁺ patients, but no differences by HAART class were found for LDL (see the table). Compared to HIV^- patients, HIV⁺ patients had lower odds of attaining ATP-III lipid goals for TC (OR 0.57, p <0.001), LDL (OR 0.81, p = 0.017), and TG (OR 0.39, p <0.001).

Conclusions:  Declines in LDL in response to LLT are similar in HIV⁺ and HIV^- patients, but declines in TC and TG levels are less prominent in HIV⁺ patients. Differences in choice of LLT among HIV⁺ due to concerns of drug–drug interactions and toxicity may in part explain results for TC.  PI+NNRTI regimens also associated with inferior TC and TG responses.

Adjusted Percentage Changes in Lipids 1 Year after LLT Initiation