Past
studies have produced conflicting data concerning the influence of HIV infection
and its treatment on metabolic complications such as elevated blood lipid levels;
the effects of specific antiretroviral agents are particularly unclear. Further,
research to date looking at this issue has included mostly men.
As
reported in the May 1, 2007 Journal of Acquired Immune Deficiency Syndromes,
Kathryn Anastos, MD, and colleagues conducted a cross-sectional metabolic analysis
of the Women's Interagency HIV Study that included 623 HIV negative and 1556 HIV
positive women. Among the HIV positive women, 636 were untreated, 419 were on
HAART regimens without protease inhibitors (PIs), and 501 were on PI-containing
HAART.
Results
• Untreated HIV positive women
had lower total cholesterol levels than HIV negative women (166 vs 177 mg/dL,
respectively).
• Women
using PI-based regimens had significantly higher total cholesterol levels compared
with both HIV negative women and women treatment with PI-sparing HAART.
• Compared with HIV negative
women, untreated HIV positive women had markedly lower high-density lipoprotein
(HDL, or "good") cholesterol and higher triglyceride (TG) levels, but
not lower low-density lipoprotein (LDL, or bad") cholesterol.
•
HIV negative women and HIV positive women using PI-sparing regimens
had similar HDL levels (55 and 53 mg/dL, respectively), which were higher than
those of both untreated HIV positive women and women who used PIs (42 and 49 mg/dL,
respectively).
• Untreated
HIV positive women were the most likely to have unfavorable HDL levels according
to National Cholesterol Education Program (NCEP) guidelines.
•
HIV positive women using PI-based regimens had higher LDL levels than
untreated HIV positive women (107 vs 100 mg/dL).
•
Women using PIs were the most likely to have unfavorable LDL and TG
levels according to NCEP guidelines.
•
Looking at the effects of specific drugs:
- 3TC (Epivir),
ddI (Videx), nevirapine (Viramune),
and efavirenz (Sustiva) were all
significantly associated with higher HDL (P < 0.001 for all).
- Ritonavir
(Norvir), ritonavir-boosted indinavir
(Crixivan), and nelfinavir (Viracept)
were significantly associated with higher LDL (P < 0.01 for all).
-
d4t (Zerit), abacavir (Ziagen),
and all ritonavir-containing regimens were associated with higher TG levels (P
< 0.05 for all).
- tenofovir (Viread)
was associated with lower TG levels (P = 0.009).
Conclusion
In
conclusion, the authors wrote, "A dyslipidemic pattern was associated with
HIV infection itself, was more severe in users of PI-containing HAART, but was
not present in women taking non-PI HAART."
This
study adds to prior evidence that PIs are most strongly associated with abnormal
lipid profiles in HIV positive people on HAART, but shows that HIV infection itself
and other types of drugs also play a role.
06/29/07
Reference K
Anastos, D Lu, Q Shi, and others. Association of Serum Lipid Levels With HIV Serostatus,
Specific Antiretroviral Agents, and Treatment Regimens. JAIDS 45(1): 34-42.
May 1, 2007.
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