Early lipid increases on HAART represent return to normal level for age group

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

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Proportions with elevations above NCEP recommended levels,

and p value compared to baseline

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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.