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Published on: July 24, 2013
Cardiovascular Disease-Risk Markers in HIV Patients
Bela F Asztalos1, Robert Matera2, Katalin V Horvath2
1Lipid Metabolism Laboratory, Human Nutrition Research Center on Aging at Tufts University, 711 Washington Street, Boston, MA, USA ; Division of Nutrition and Infection, Department of Public Health and Community Medicine, Tufts University School of Medicine, 150 Harrison Avenue, Boston, MA, USA.
Insights
HIV patients exhibit altered HDL cholesterol, with low levels of large HDL particles and increased small HDL particles. Metabolic syndrome components and viral load contribute to cardiovascular disease risk, necessitating tailored lipid management strategies.
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Lipidology
Background:
- HIV infection is associated with an elevated risk of cardiovascular disease (CVD).
- The specific mechanisms driving increased CVD risk in HIV-positive individuals remain incompletely understood.
- Understanding traditional and emerging CVD risk factors in HIV is crucial for effective management.
Purpose of the Study:
- To evaluate traditional and emerging cardiovascular disease (CVD) risk factors within the CARE Study cohort of HIV-infected adults.
- To investigate the relationship between lipid profiles, metabolic syndrome components, and subclinical atherosclerosis (cIMT) in HIV-positive patients.
Main Methods:
- Analysis of demographic and clinical data from 176 HIV-positive subjects.
- Assessment of viral load, CD4 count, antiretroviral therapy (ART) regimens, and carotid intima-media thickness (cIMT).
- Evaluation of lipid homeostasis markers, including high-density lipoprotein (HDL) and triglyceride (TG) levels, and insulin resistance.
Main Results:
- No significant association was found between LDL-C levels and cIMT.
- HIV patients displayed significantly lower levels of large HDL particles and higher levels of small HDL particles compared to the general population.
- Metabolic syndrome components (high TG/low HDL-C, insulin resistance, high BMI) and viral load were significant contributors to increased cIMT.
Conclusions:
- The primary lipid abnormalities in this HIV-positive cohort were low HDL-C and high TG levels, with normal LDL-C.
- HIV infection and its treatment may impair cholesterol efflux from macrophages via ABCA1, contributing to CVD risk.
- Reducing CVD risk in HIV patients may necessitate lower LDL-C goals and improved TG control, considering impaired cholesterol efflux mechanisms.
Objectives:
HIV-positive patients have an increased risk for CVD; however, the underlying mechanisms are not well understood. Our goal was to assess traditional and emerging CVD-risk factors in the CARE Study, a well-described cohort of HIV-infected adults.
Methods:
We analyzed demographic and clinical (viral load, CD4 count, ART regimen, cIMT) data including markers of lipid and glucose homeostasis in 176 HIV-positive subjects receiving regular care for HIV infection.
Results:
No significant association between cIMT and LDL-C level was observed. HIV patients had significantly lower level of the large α-1 HDL particles and about 3-fold higher level of the small pre β-1 HDL particles than the normal population, but these parameters were not significantly associated with cIMT. Components of the metabolic syndrome, high TG/low HDL-C, insulin resistance and high BMI, as well as viral load were significant but moderate contributors to increased cIMT.
Conclusion:
The major lipid disorder was low HDL-C and high TG level in this HIV-positive cohort. LDL-C was not elevated. These and previously published data indicate that HIV infection and HIV medications influence CVD risk by impairing cholesterol removal (efflux) via ABCA1 from macrophages. Decreasing CVD risk in HIV patients, with impaired cholesterol efflux from macrophages, may require a lower LDL-C goal than recommended for HIV-negative patients and also a better control of TG level.
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