Association of non-HDL cholesterol with subclinical atherosclerosis in HIV-positive patients

Objectives: To assess the relationship between non-classical cardiovascular (CV) risk factors including non-HDL cholesterol (non-HDL-C), apolipoprotein B, triglycerides to HDL ratio, LDL size, inflammation or oxidative stress parameters and carotid intima-media thickness (CIMT), in order to better identify prevention or therapeutic targets. In addition, we studied the relationship between metabolic syndrome (MS) and CIMT. Methods: Cross-sectional study including 232 HIV-positive (HIV+) adults (80% treated by combined antiretroviral therapy) extracted from the ANRS CO3 Aquitaine Cohort. Results: There was a significant association of higher non-HDL-C (p < 0.01), apolipoprotein B (p < 0.01) levels or TG/HDL ratio (p < 0.05) with higher CIMT when compared the first vs fourth quartile, while there is no association between CIMT and LDL-C (p = 0.09) or LDL size (p = 0.55). In multivariate analysis, only the TG/HDL molar ratio > 1.5 tend toward significance (p = 0.08). MS was observed in only 7.3% of patients with the NCEP-ATP III definition and 11.2% with the IDF criteria. Whatever the used definition, there was a significant association between MS presence and increased CIMT (p < 0.05) in univariate and multivariate model. Conclusions: Non-HDL-C, TG/HDL ratio and apolipoprotein B levels, which are closely linked to lipid disorders associated to the MS, appear as stronger predictive markers than LDL-C for screening subclinical atherosclerosis in HIV+ populations. Achieving non-HDL-C target defined by the NCEP-ATP III guidelines appears of great importance to reduce CV complications in HIV+ patients. (c) 2008 The British Infection Society. Published by Elsevier Ltd. All rights reserved.