Sex differences in HAART-associated dyslipidaemia.
OBJECTIVE
Because female sex protects against dyslipidaemia and atherosclerosis in normal subjects, we aimed to reveal potential sex differences in metabolic side-effects of a newly initiated highly active antiretroviral therapy (HAART) regimen, and to relate these changes to endothelial cell activation as measured by levels of circulating E-selectin (cE-selectin).


METHODS
Prospective longitudinal cohort study.


METHODS
Tertiary care centre at a University Hospital.


METHODS
HIV-seropositive male (n = 27) and female patients (n = 13) with a plasma viral load of > or = 10 000 copies/ml and 35 healthy controls were enrolled in the study. All participants were weight stable, free of acute opportunistic infections, and had not taken any protease inhibitors before. Serum levels of lipids, insulin, leptin, and cE-selectin were measured before initiation of HAART, and at 3 and 6 months thereafter.


RESULTS
HAART increased serum levels of triglycerides, leptin, and low-density lipoprotein (LDL) cholesterol; these effects were more distinct in women. Fasting insulin levels and the LDL : high density lipoprotein (HDL) ratio increased only in female HIV-infected patients (P < 0.02 versus men). In contrast, endothelial activation, as measured by cE-selectin, decreased more in men (P < 0.02) than in women. As a consequence, women had higher triglycerides and leptin levels after therapy than did men, and the LDL : HDL ratio and cE-selectin levels, which were initially higher in men, were no longer different between the sexes.


CONCLUSIONS
Metabolic adverse effects during HAART are more pronounced in women than in men. Hence, female HIV-infected patients seem to loose part of their natural protection from atherosclerosis during antiretroviral therapy.
Pernerstorfer-Schoen
H
H
Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, University of Vienna Medical School, Vienna General Hospital, Vienna, Austria.
Jilma
B
B
Perschler
A
A
Wichlas
S
S
Schindler
K
K
Schindl
A
A
Rieger
A
A
Wagner
O F
OF
Quehenberger
P
P
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D001823:Body Composition; D001835:Body Weight; D018791:CD4 Lymphocyte Count; D019040:E-Selectin / Q000097:blood; D004730:Endothelium, Vascular / Q000378:metabolism; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D006949:Hyperlipidemias / Q000139:chemically induced*; D007328:Insulin / Q000097:blood; D020738:Leptin / Q000097:blood; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012737:Sex Factors; D019562:Viral Load
D019040:E-Selectin; D007328:Insulin; D020738:Leptin; D008055:Lipids