A
review of lipid increases after commencing HAART in 50 HIV seroconverters from
the Multicenter AIDS Cohort Study (MACS) shows that many people are
experiencing cholesterol elevations that put them back to levels registered
prior to seroconversion. On average, the treated individuals attained lipid
levels that equalled those seen in a large US study of HIV-negative
individuals, suggesting that lipid elevations on HAART represent normalisations
of lipid metabolism, and should only cause concern when they breach the
thresholds laid down in the US NCEP guidelines for managing cardiovascular
risk.
The
findings were presented last week at the Tenth Conference on Retroviruses and
Opportunistic Infections in Boston by researchers from the University of
Pittsburgh, Johns Hopkins University and other participants in the Multicenter
AIDS Cohort Study (MACS).
They
represent the latest effort to determine which lipid increases on HAART pose a
serious risk of cardiovascular disease, and follow on from the observation of
cholesterol declines prior to the introduction of HAART in untreated people
with HIV.
The
researchers identified 50 men who had baseline cholesterol measurements
recorded on entry to the cohort, and who subsequently became infected with HIV
during the 1980s. Lipid measurements were subsequently recorded at four time
points: prior to commencing HAART, and on three occasions during an average
follow-up of three years on HAART. These measurements were compared with
average levels found in the NHANES III cohort study, which collected
information on lipid levels in the non-HIV infected male population aged 20 and
above.
The
interval between the baseline measurement and the last measurement on HAART
averaged 11.6 years, with an average of three years spent on HAART.
Lipid changes from pre-seroconversion baselines
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman";
color:white'>Cholesterol (mg/dl)
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman";
color:white'>baseline
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman";
color:white'>Post-seroconversion
style='font-family:Arial;mso-bidi-font-family:"Times New Roman";color:maroon'>
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman";
color:white'>Change from baseline after 3 years HAART
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman";
color:maroon'>
Total cholesterol
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman"'>203
(+/- 48)
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman"'>-30
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman"'>
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman"'>+50
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman"'>
HDL cholesterol
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman"'>52
(+/- 14)
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman"'>-12
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman"'>-9
LDL cholesterol
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman"'>121
(+/- 37)
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman"'>-22
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman"'>+21
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman"'>
Proportions with elevations above NCEP recommended levels,
and p value compared to baseline
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman"'>
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman";
color:white'>Cholesterol threshold (mg/dl)
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman";
color:white'>baseline
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman";
color:white'>Post-seroconversion
style='font-family:Arial;mso-bidi-font-family:"Times New Roman";color:maroon'>
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman";
color:white'>After 3 years HAART
style='font-family:Arial;mso-bidi-font-family:"Times New Roman";color:maroon'>
Total cholesterol > 240
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman"'>20%
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman"'>4%
(p<0.01)
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman"'>29%
(ns)
HDL cholesterol < 40
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman"'>16%
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman"'>68%
(p<0.01)
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman"'>44%
LDL cholesterol > 160
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman"'>18%
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman"'>2%
(p<0.01)
lang=EN-US style='font-family:Arial;mso-bidi-font-family:"Times New Roman"'>19%
(ns)
The
investigators say that the increases seen after commencing HAART resulted in a
return of cholesterol to the level that would be expected in individuals of
that age (the mean age of seroconverters was 34).
The
researchers concluded that HIV infection results in reductions in total
cholesterol, HDL and LDL cholesterol, but that HDL cholesterol still remains
below pre-infection levels after starting HAART. They recommend longer term
follow-up to determine whether further changes in cholesterol match those seen
with aging, or whether they exceed the elevations seen in the general
population.
Reference
style='font-size:12.0pt;font-family:"Times New Roman"'>Riddler S et al.
lang=EN-US>
style='font-size:12.0pt;font-family:Arial;font-weight:normal'>Serum lipids and
antiretroviral therapy among HIV-infected men. Tenth Conference on Retroviruses
and Opportunistic Infections, Boston, February 10-14, 2003, abstract 750.
lang=EN-US>