Determinants of low-density lipoprotein particle diameter during antiretroviral therapy including protease inhibitors in HIV-1-infected patients.
BACKGROUND
Lipid disorders are frequent in HIV-1-infected patients taking combination antiretroviral therapy (cART) that includes protease inhibitors (PIs). The presence of small dense low-density lipoprotein particles might be an important predictive marker of cardiovascular disease in this setting. This cross-sectional substudy of the ANRS 126 trial was designed to identify variables influencing LDL diameter.


METHODS
We studied 81 stable HIV-1-infected patients with dyslipidaemia (LDL-cholesterol >4.1 mmol/l, triglycerides <8.8 mmol/l) receiving PI-including cART regimens and no lipid-lowering drugs. LDL diameter was assessed by gradient gel electrophoresis. Relationships between LDL diameter and demographic, metabolic and HIV-related variables were identified by using non-parametric univariate tests and multiple linear regression models.


RESULTS
In univariate analysis, LDL diameter was related to demographic variables, triglyceride (TG) levels, high-density lipoprotein cholesterol (HDL-c) levels, and the numbers and duration of exposure to nucleoside reverse transcriptase inhibitors and PIs. In multivariable linear regression analysis, LDL diameter was negatively associated with the TG level (P<0.0001) and positively associated with the HDL-c level (P<0.0001). For each 1-mmol/l increase in TG, LDL diameter fell by 0.281 nm. Conversely, for each 1-mmol/l increase in HDL-c, LDL diameter rose by 1.175 nm.


CONCLUSIONS
Higher TG and lower HDL-c levels are associated with smaller LDL particle diameter. Small-diameter LDL particles could contribute to early atherogenic processes in HIV-1-infected patients on cART.
Unité Fonctionnelle de Biochimie des Maladies Métaboliques, Service de Biochimie Métabolique, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France. randa.bittar@psl.aphp.fr
Randa
R
Bittar
Philippe
P
Giral
Elisabeth
E
Aslangul
Lambert
L
Assoumou
Marc-Antoine
MA
Valantin
Olga
O
Kalmykova
Valérie
V
Fesel-Fouquier
Dominique
D
Costagliola
Dominique
D
Bonnefont-Rousselot
D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000378:metabolism*; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D006801:Humans; D008055:Lipids / Q000097:blood; D008077:Lipoproteins, LDL / Q000737:chemistry / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010316:Particle Size
D017320:HIV Protease Inhibitors; D008055:Lipids; D008077:Lipoproteins, LDL