Differentiating hyperlipidaemia associated with antiretroviral therapy.
BACKGROUND
Hyperlipidaemia associated with antiretroviral treatment has led to concerns for an increased cardiovascular risk in HIV-infected patients.


OBJECTIVE
To assess this cardiovascular risk by comparing the lipoprotein pattern of antiretroviral-treated and untreated HIV-positive patients with patients with familial combined hyperlipidaemia (high cardiovascular risk) or familial hypertriglyceridaemia (low cardiovascular risk).


METHODS
Fasting serum samples were drawn from consecutive patients with HIV infection or lipoprotein disorders. Total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, triglycerides, apolipoprotein A1 and B were determined in serum. Very low density lipoprotein (VLDL) was prepared by ultracentrifugation and analysed for cholesterol, triglycerides and apolipoprotein B.


RESULTS
Lipoprotein disorders were found in 114/187 HIV-positive patients (61%). Of these, according to the Fredrickson classification, 10% were type IIa (elevated LDL-cholesterol), 14% type IIb (elevated LDL- and VLDL-cholesterol) and 76% were type IV (elevated VLDL-cholesterol). VLDL composition was analysed in 34 HIV-positive patients with type IV hyperlipidaemia. The ratio of VLDL-triglycerides to VLDL-apolipoprotein B in these patients was 16.2 +/- 6.0. This ratio was not different from 14 patients with famlial hypertriglyceridaemia (16.9 +/- 6.0; = 0.61), but differed substantially from 10 patients with familial combined hyperlipidaemia (6.8 +/- 1.0; < 0.0001).


CONCLUSIONS
In HIV-infected patients with high VLDL, large VLDL particles were found with no increase in number. This pattern resembles familial hypertriglyceridaemia. It is different from familial combined hyperlipidaemia, where an increase in number of small-sized VLDL particles occurs. Further research is needed to assess the contribution of VLDL-associated hypercholesterolaemia in those taking antiretroviral drugs to the cardiovascular risk profile of HIV-positive patients.
Mauss
Stefan
S
Center for HIV and Hepatogastroenterology, Duesseldorf, Germany.
Stechel
Juergen
J
Willers
Reinhard
R
Schmutz
Guenther
G
Berger
Florian
F
Richter
Werner O
WO
D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015243:Cholesterol, VLDL / Q000097:blood; D005260:Female; D017320:HIV Protease Inhibitors / Q000009:adverse effects; D054303:HIV Reverse Transcriptase / Q000037:antagonists & inhibitors; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000139:chemically induced; D006950:Hyperlipidemia, Familial Combined / Q000097:blood; D006949:Hyperlipidemias / Q000097:blood / Q000139:chemically induced* / Q000150:complications; D006953:Hyperlipoproteinemia Type IV / Q000097:blood; D008079:Lipoproteins, VLDL / Q000097:blood; D008297:Male; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects; D014280:Triglycerides / Q000097:blood
D019380:Anti-HIV Agents; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D015243:Cholesterol, VLDL; D017320:HIV Protease Inhibitors; D008079:Lipoproteins, VLDL; D018894:Reverse Transcriptase Inhibitors; D014280:Triglycerides; D054303:HIV Reverse Transcriptase