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Decrease in LDL size in HIV-positive adults before and after lopinavir/ritonavir-containing regimen: an index of
S Badiou1, C Merle De Boever, A M Dupuy
1Department of Biochemistry, University Hospital, 191 av du doyen Gaston Giraud, Montpellier 34295, France.
Atherosclerosis
|May 7, 2003
Summary
Highly active antiretroviral therapy (HAART) can worsen hypertriglyceridemia (HTG) and small dense low-density lipoprotein (sdLDL) levels. Lopinavir/ritonavir regimens exacerbate this atherogenic lipid profile, suggesting fibrates as a potential management strategy.
Area of Science:
- Cardiology
- HIV Medicine
- Lipid Metabolism
Background:
- Hypertriglyceridemia (HTG) is common in patients on highly active antiretroviral therapy (HAART), particularly those on protease inhibitors.
- Apolipoprotein CIII (apoCIII) may contribute to HTG by inhibiting triglyceride hydrolysis, leading to increased small dense low-density lipoprotein (sdLDL), a cardiovascular risk factor.
Purpose of the Study:
- To investigate the impact of lopinavir/ritonavir-containing regimens on the lipoprotein profile of HIV-infected adults.
- To characterize changes in lipid parameters and LDL size associated with HAART.
Main Methods:
- A study involving 24 HIV-infected adults and 14 healthy controls.
- Measurement of serum lipid parameters, lipoprotein composition, and LDL size before and at 1 and 3 months after initiating a lopinavir/ritonavir regimen.
Main Results:
- Baseline atherogenic lipid profile in HIV patients included moderate HTG, smaller LDL size, and high prevalence of sdLDL compared to controls.
- Lopinavir/ritonavir treatment significantly reduced LDL size and increased total cholesterol, triglycerides, apoA1, apoB, apoCIII, and TG percentages in LDL and HDL.
Conclusions:
- Advanced HIV infection is linked to an atherogenic lipid profile with a high prevalence of sdLDL.
- Lopinavir/ritonavir-containing regimens worsen LDL size reduction.
- Fibrates may be a suitable option for managing HAART-induced HTG due to their triglyceride-lowering and LDL size-increasing effects.