Changes in lipids and lipoprotein particle concentrations after interruption of antiretroviral therapy.
BACKGROUND
The effect of interruption of antiretroviral therapy (ART) on lipoprotein particle subclasses has not been studied. We examined short-term changes in lipids and lipoprotein particles among 332 HIV-infected individuals randomized to interrupt or continue ART in the "Strategies for Management of Antiretroviral Therapy" trial.


METHODS
Lipids and lipoprotein particles measured by nuclear magnetic resonance spectroscopy were compared between randomized groups at month 1; associations with inflammatory and coagulation markers (high sensitivity C-reactive protein; interleukin 6; amyloid A; amyloid P; D-dimer; prothrombin fragment 1 + 2) were assessed.


RESULTS
Compared with continuation of ART, treatment interruption resulted in substantial declines in total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, and triglyceride, at month 1 but had little net effect on total/HDL cholesterol ratio [baseline-adjusted mean difference [95% confidence interval (CI)] interruption versus continuation arms: -0.10 (-0.59 to 0.38); P = 0.67]. ART interruption resulted in declines in total, large, and medium very low density lipoprotein (VLDL) particle concentrations (VLDL-p) and total and medium HDL-p. However, there was no change in small HDL-p [baseline-adjusted percentage difference between arms: -4.6% (-13.1%, +5.1% ); P = 0.35], small LDL-p [-5.0% (-16.9%, +8.6%); P = 0.45], or other LDL-p subclasses. Changes in lipid parameters on ART interruption did not differ according to baseline ART class (protease inhibitor versus non-nucleoside reverse transcriptase inhibitor) but were negatively associated both with changes in HIV viral load and with changes in inflammatory and coagulation markers, particularly D-dimer.


CONCLUSIONS
These results suggest that ART interruption does not favorably influence overall lipid profile: there was little net effect on total/HDL cholesterol ratio, and no change in small LDL-p or small HDL-p, the lipoprotein particle subclasses most consistently linked to coronary risk. Short-term declines in lipid parameters after ART interruption were not associated with class of ART and may be linked to increases in viral replication, inflammation and coagulation.
Lampe
Fiona C
FC
Research Department of Infection and Population Health, University College London, London, United Kingdom. f.lampe@pcps.ucl.ac.uk
Duprez
Daniel A
DA
Kuller
Lewis H
LH
Tracy
Russell
R
Otvos
James
J
Stroes
Erik
E
Cooper
David A
DA
Hoy
Jennifer
J
Paton
Nick I
NI
Friis-Møller
Nina
N
Neuhaus
Jacquie
J
Liappis
Angelike P
AP
Phillips
Andrew N
AN
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy* / Q000208:ethnology; D006801:Humans; D008055:Lipids / Q000097:blood*; D008074:Lipoproteins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D013997:Time Factors
D019380:Anti-HIV Agents; D015415:Biomarkers; D008055:Lipids; D008074:Lipoproteins