Protease inhibitor related type III hyperlipoproteinaemia is common and not associated with apolipoprotein-E E2/E2 phenotype.
OBJECTIVE
To determine the prevalence of type III hyperlipoproteinaemia in a cohort of HIV infected patients taking protease inhibitors and its correlation with the apolipoprotein-E2 isoform.


METHODS
Cross sectional study of 57 consecutive HIV infected subjects taking protease inhibitor therapy for a median of 12.5 (1-29) months, seen in an outpatient HIV clinic. Controls were 17 patients on non-nucleoside reverse transcriptor inhibitor therapy (NNRTI) for 9 (1-19) months and 50 antiviral naive patients.


METHODS
Fasting cholesterol, triglyceride, HDL cholesterol, lipoprotein (a), and glucose were measured. Lipoprotein electrophoresis was performed on patients with a cholesterol >6.5 mmol/l and a triglyceride concentration of >4.5 mmol/l. Apolipoprotein-E phenotype was determined in serum.


RESULTS
Dyslipidaemia was found in 43 (75%) PI treated patients-37 with triglyceride >2.3 mmol/l, 30 with cholesterol >6.5 mmol/l, and nine with HDL cholesterol <0.9 mmol/l. 38% had a lipoprotein (a) >300 mg/l. 11 patients (19.3%) had a type III hyperlipoproteinaemia pattern. Only one was homozygous for the E2 phenotype and none had clinical diabetes. An additional patient had a serum lipid profile compatible with type III hyperlipoproteinaemia and an E3/E2 phenotype in whom electrophoresis was not carried out before treatment. Six (35%) of the NNRTI and 16 (32%) of the antiviral naive patients had dyslipidaemia. 18 (31.6%) of the PI and none of the control patients had a cholesterol and/or triglyceride >8 mmol/l.


CONCLUSIONS
Type III hyperlipoproteinaemia is common in this group of patients and need not be associated with the apolipoprotein-E2/E2 isoform. HIV protease inhibitors may interfere with lipoprotein receptor related protein.
Shahmanesh
M
M
Department of Genitourinary Medicine, University Hospital Birmingham NHS Trust, Selly Oak Hospital, Birmingham, UK. mohse.shahmanesh@bscht.wmids.nhs.uk
Jaleel
H
H
DeSilva
Y
Y
Ross
J D
JD
Caslake
M
M
Cramb
R
R
D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D001057:Apolipoproteins E / Q000097:blood*; D015153:Blotting, Western; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004587:Electrophoresis, Agar Gel; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000235:genetics; D006720:Homozygote; D006801:Humans; D006952:Hyperlipoproteinemia Type III / Q000139:chemically induced* / Q000235:genetics; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011480:Protease Inhibitors / Q000627:therapeutic use*; D020033:Protein Isoforms / Q000235:genetics
D001057:Apolipoproteins E; D011480:Protease Inhibitors; D020033:Protein Isoforms