Protease inhibitor-based HAART, HDL, and CHD-risk in HIV-infected patients

Objective: To study the effects of HIV-infection and protease inhibitor (PI)-based highly active anti-retroviral therapy (HAART) on the lipid and high-density lipoprotein (HDL) subpopulation profile and to relate the changes to coronary heart disease (CHD)-risk. Methods and design: The lipid and HDL subpopulation profiles of HIV-positive subjects (n = 48) were studied prospectively by comparing pre- and post-PI-HAART data as well as cross-section by comparing the profiles to HIV-negative subjects with (n = 96) and without CHD (n = 96). Results: HIN-infected HAART-naive subjects had lower concentrations of low-density lipoprotein cholesterol (LDL-C) and HDL-C and higher concentration of triglycerides (TG) than healthy controls. After receiving PI-based HAART, LDL-C and TG concentrations increased, while HDL-C concentrations remained unchanged. The HDL subpopulation profiles of HAART-naive HIV-positive patients were significantly different from those of healthy controls and were similar to those with CHID. Moreover, the HDL subpopulation profile changed unfavorably after PI-based HAART, marked with increased concentrations of the small, lipid-poor pre-beta-1 HDL (32% or 3.9mg/dl; p < 0.001), and decreased concentration of the large, cholesterol-rich alpha-1 HDL(9% or 1 mg/dl ns). Conclusion: An already unfavorable lipid and HDL subpopulation profile of HIV-positive HAART-naive subjects further deteriorated after receiving PI-based treatment, which may cause increased CHD-risk in these subjects. (c) 2005 Elsevier Ireland Ltd. All rights reserved.