title: Lipoprotein-associated phospholipase A2 and cardiovascular disease risk in HIV infection.
abstract: OBJECTIVE
  HIV-infected patients on antiretroviral therapy (ART) have an increased cardiovascular disease (CVD) risk as a result of heightened inflammation and immune activation, despite at times having normal lipids and few traditional risk factors. Biomarkers are needed to identify such patients before a clinical event. Lipoprotein-associated phospholipase A2 (Lp-PLA2 ) predicts CVD events in the general population. This study investigated the relationship between Lp-PLA2 and markers of CVD risk, systemic inflammation, immune activation, and coagulation in HIV infection.
  
  
  METHODS
  One hundred subjects on stable ART with normal fasting low-density lipoprotein (LDL) cholesterol were enrolled in the study. Plasma Lp-PLA2 concentrations were measured by enzyme-linked immunosorbent assay (ELISA; > 200 ng/mL was considered high CVD risk). Subclinical atherosclerosis, endothelial function, inflammation, immune activation and fasting lipids were also evaluated.
  
  
  RESULTS
  The median age of the patients was 47 years and 77% were male. Median (range) Lp-PLA2 was 209 (71-402) ng/mL. Fifty-seven per cent of patients had Lp-PLA2 concentrations > 200 ng/mL. Lp-PLA2 was positively correlated with soluble markers of inflammation or immune activation (tumour necrosis factor receptor-II, intercellular and vascular cellular adhesion molecules, and CD14; all R = 0.3; P < 0.01), and negatively correlated with coagulation markers (D-dimer and fibrinogen; both R = -0.2; P < 0.04). Lp-PLA2 was not correlated with lipids, coronary artery calcium score, or flow-mediated vasodilation, but trended towards a significant correlation with carotid intima-media thickness (R = 0.2; P = 0.05).
  
  
  CONCLUSIONS
  In this population with stable ART and normal LDL cholesterol, Lp-PLA2 was in the high CVD risk category in the majority of subjects. Lp-PLA2 appears to be associated with inflammation/immune activation, but also with anti-thrombotic effects. Lp-PLA2 may represent a valuable early biomarker of CVD risk in HIV infection before subclinical atherosclerosis can be detected.
authors.affiliation: Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Ross Eckard
authors.forename: C T
authors.initials: CT
authors.lastname: Longenecker
authors.forename: Y
authors.initials: Y
authors.lastname: Jiang
authors.forename: S M
authors.initials: SM
authors.lastname: Debanne
authors.forename: D
authors.initials: D
authors.lastname: Labbato
authors.forename: N
authors.initials: N
authors.lastname: Storer
authors.forename: G A
authors.initials: GA
authors.lastname: McComsey
mesh_terms: D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase / Q000097:blood / Q000276:immunology*; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D015415:Biomarkers / Q000097:blood; D059168:Carotid Intima-Media Thickness; D003324:Coronary Artery Disease / Q000201:enzymology / Q000503:physiopathology* / Q000821:virology; D003430:Cross-Sectional Studies; D004797:Enzyme-Linked Immunosorbent Assay; D015658:HIV Infections / Q000201:enzymology / Q000276:immunology / Q000503:physiopathology*; D006801:Humans; D007249:Inflammation / Q000276:immunology / Q000503:physiopathology* / Q000821:virology; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase
keywords: HIV; cardiovascular disease; carotid intima-media thickness; coagulation; immune activation; inflammation; lipoprotein-associated phospholipase A2