Hyperhomocysteinaemia in HIV-infected patients: determinants of variability and correlations with predictors of cardiovascular disease.
OBJECTIVE
We evaluated hyperhomocysteinaemia (HHcy) in a cohort of HIV-infected patients in order to assess its relation to cardiovascular risk (CVR) and identify determinants of HHcy variability.


METHODS
Cross-sectional observational study. HIV-infected patients on stable highly active antiretroviral therapy (ART) were evaluated for the presence of the metabolic syndrome, lipodystrophy and traditional CVR factors. Plasma homocysteine levels were measured using high-performance liquid chromatography.


RESULTS
Five hundred and sixty-seven patients (38% female) with a median age of 44 years were included in the study. Homocysteine (Hcy) was significantly higher in patients with the metabolic syndrome and lipodystrophy. No significant association was found between Hcy levels and the use of ART. However, Hcy was associated with higher blood pressure, waist circumference and waist-to-hip ratio, total lean body mass, visceral adipose tissue (VAT), VAT/total adipose tissue, homeostasis model assessment of insulin resistance (HOMA-IR), triglycerides, high-density lipoprotein cholesterol, apolipoprotein A1, B, and creatinine. All 10-year CVR assessment scores were significantly associated with Hcy. In a multivariate regression model, systolic blood pressure, vitamin supplementation and HOMA-IR were significantly and independently related to Hcy.


CONCLUSIONS
Hcy is elevated in HIV-infected patients and is significantly associated with increased CVR. Measurement of Hcy might be useful in identifying particularly high-risk populations at whom therapeutic interventions could be targeted.
Guaraldi
G
G
Department of Medicine and Medical Specialties, Infectious Diseases Clinic, Emilia School of Medicine, University of Modena and Reggio Emilia, Modena, Italy. g.guaraldi@unimo.it
Ventura
P
P
Garlassi
E
E
Orlando
G
G
Squillace
N
N
Nardini
G
G
Stentarelli
C
C
Zona
S
S
Marchini
S
S
Moriondo
V
V
Tebas
P
P
D000328:Adult; D000886:Anthropometry; D023241:Antiretroviral Therapy, Highly Active; D015415:Biomarkers; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000378:metabolism; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000378:metabolism; D015497:HIV-1; D039682:HIV-Associated Lipodystrophy Syndrome / Q000150:complications* / Q000378:metabolism; D006710:Homocysteine / Q000097:blood; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications* / Q000378:metabolism; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000378:metabolism; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment
D015415:Biomarkers; D006710:Homocysteine