Lipoprotein(a) in patients initiating antiretroviral therapy.
OBJECTIVE
The interaction between lipoprotein(a), an emerging cardiovascular risk factor, and antiretrovirals (ARVs) has been less well studied than the interaction between either cholesterol or triglycerides and these drugs. In this study we assessed the effect of initiating antiretroviral therapy (ART) on lipoprotein(a) levels.


METHODS
Fasting samples from 95 patients initiating ART with nucleoside/nucleotide reverse transcriptase inhibitors plus nonnucleoside reverse transcriptase inhibitors or protease inhibitors were obtained. Lipids and lipoproteins were determined until week 48.


RESULTS
As in the general population, the study population showed a highly skewed lipoprotein(a) distribution (median 9.9 mg/dL, range 0.1-110 mg/dL). The study population was divided into individuals with lipoprotein(a) >or=30 mg/dL at baseline (n=28) and those with <30 mg/dL (n=67). Almost exclusively, patients with high lipoprotein(a) at baseline (median 51.6 mg/dL) showed a profound increase of median 26.7 mg/dL (week 24). This effect was not associated with specific ARVs and was independent of changes in other lipids. The low-lipoprotein(a) group (baseline median 7 mg/dL) showed a small increase of median 2.6 mg/dL (week 24).


CONCLUSIONS
Marked increases in lipoprotein(a) after initiation of ART were mainly restricted to patients with high baseline levels. This may have clinical implications as patients with high lipoprotein(a) are at higher risk for myocardial infarction and stroke.
Mauss
S
S
Center for HIV and Hepatogastroenterology, Duesseldorf, Germany. stefan.mauss@center-duesseldorf.de
Berger
F
F
Schmutz
G
G
Henke
J
J
Richter
W O
WO
D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000009:adverse effects* / Q000378:metabolism; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects* / Q000378:metabolism; D015497:HIV-1; D006801:Humans; D017270:Lipoprotein(a) / Q000187:drug effects / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects / Q000378:metabolism; D019438:Ritonavir / Q000009:adverse effects* / Q000378:metabolism; D019562:Viral Load; D055815:Young Adult
D044966:Anti-Retroviral Agents; D017320:HIV Protease Inhibitors; D017270:Lipoprotein(a); D018894:Reverse Transcriptase Inhibitors; D019438:Ritonavir