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HIV11: Lipid Levels Are Higher among HIV+ People on ART, Immune Suppression May Play a Role

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People with HIV on suppressive antiretroviral therapy (ART) have "considerably higher" blood lipid levels relative to untreated individuals or those on less effective treatment, researchers reported at the 11th International Congress on Drug Therapy in HIV Infection (HIV11) last month in Glasgow. They also found that greater immune deficiency, as indicated by lowest-ever CD4 count, was associated with lipid elevations.

David Kamara fromUniversity College London and colleagues evaluated the effect of ART, HIV viral load, and immune suppression on blood levels of lipids among participants in the D:A:D (Data Collection on Adverse events of Anti-HIV Drugs) study.

The analysis included data from nearly 50,000 HIV positive D:A:D participants. Most (74%) were men, about half were white, and the median age was 38 years. About 60% were ART-experienced; 61% had been exposed to nucleoside/nucleotide reverse transcriptase inhibitors, 47% to protease inhibitors, and 29% to NNRTIs. The median current CD4 T-cell count was 400 cells/mm3 while the median nadir (lowest-ever) level was 240 cells/mm3. About 20% had a prior AIDS diagnosis.

The researchers looked at associations between first available total cholesterol, HDL "good" cholesterol, and triglyceride measurements after enrollment in the cohort, along with use of ART, viral load, and CD4 count measured at the same time.

ART and viral load were combined in the following categories: off ART with viral load >100,000 copies/mL; off ART with viral load <100,000 copies/mL; on ART with viral load >500 copies/mL; or on ART with viral load >500 copies/mL. Current and nadir CD4 counts were categorized as: <200, 200-349, 350-499, or >500 cells/mm3.

Results

  • 45,169 out of 49,734 D:A:D participants (91%) contributed a total cholesterolmeasurement; 44,322 (89%) a triglyceridemeasurement; and 38,604 (78%) a HDL measurement.
  • People on ART with suppressed viral load had higher levels of all 3 lipids than participants not on HIV treatment.
  • Non-suppressive ART was also associated with lower total cholesterol and HDL levels, though it had no effect on triglyceride levels.
  • Low current CD4 count was associated with lower levels of all lipids.
  • Low nadir CD4 count, however, was associated with higher total cholesterol and triglyceride levels.
  • Prior AIDS diagnosis was associated with higher total cholesterol and triglyceride levels, but lower HDL levels.

"Although specific drug classes were not considered, lipid levels are considerably higher in those on a suppressive ART regimen," the researchers concluded. "The higher total cholesterol/triglyceride and lower [HDL] levels seen among those with low nadir CD4 count and with a prior AIDS diagnosis suggests severe immunosuppression may be associated with dyslipidemia over the long-term."

12/14/12

Reference

D Kamara, C Sabin, P Reiss, et al. Impact of antiretroviral therapy (ART), immunosuppression and viraemia on lipid levels: the D:A:D study. 11th International Congress on Drug Therapy in HIV Infection (HIV11). Glasgow, November 11-15, 2012. Abstract P34.