Untreated HIV-infected women have lower levels of high-density lipoprotein cholesterol (HDL-C) and higher triglyceride levels compared with uninfected women, according to data from the Women's Interagency HIV Study. This pattern is aggravated by treatment that includes protease inhibitors.
The study investigators, led by Dr. Kathryn Anastos from the Montefiore Medical Center in the Bronx, New York, characterized serum lipid levels of 2179 women, of whom 623 were HIV-negative. They report their findings in the Journal of Acquired Immune Deficiency Syndromes for May 1.
Among those infected by HIV, 636 were on no medications, 501 were on HAART that included a protease inhibitor, and 419 were on HAART without a protease inhibitor.
Subjects using a protease inhibitor were the most likely of the four groups to have elevated levels of LDL-C and triglycerides, as defined by National Cholesterol Education Program guidelines. The protease inhibitor atazanavir, without ritonavir, was the only exception.
Untreated HIV-positive women were the group most likely to have unfavorable HDL-C levels, but LDL-C levels were not elevated, "unlike the findings in previous reports on men," the authors note.
Still, "In population-based studies, differences of this magnitude in lipoprotein levels have been shown to increase the risk of cardiovascular events by 20% to 30%," they add.
Among women taking HAART not containing a protease inhibitor, HDL levels were similar to those of uninfected women, at 55 and 53 mg/dL, respectively. They were more likely to have HDL-C levels higher than those of untreated, infected women and women taking a protease inhibitor (42 and 49 mg/mL).
Protease inhibitors were associated with higher LDL-C levels, which the authors suggest "may be a true adverse effect and not just the result of renewed health from effective ART."
"Specifically, lamivudine, didanosine, tenofovir, atazanavir, and non-protease inhibitor treatment regimens were associated with less dyslipidemia, potentially mitigating an adverse effect of HIV infection on cardiovascular risk," they found. In contrast, "Increased dyslipidemia was associated with stavudine, nelfinavir, lopinavir, and ritonavir."
J Acquir Immune Defic Syndr 2007;45:34-42.
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