title: Treatment of HIV infection with a raltegravir-based regimen increases LDL levels, but improves HDL cholesterol efflux capacity.
abstract: Persons infected with HIV often have altered lipid profiles that may be affected by antiretroviral therapies (ART). Traditional lipid measurements may be insufficient to assess cardiovascular disease (CVD) risk in this population.
  
  
  
  We report results from 39 ART-naive participants in a substudy of A5248, a single-arm study of raltegravir, emtricitabine/tenofovir administration. Samples were collected at baseline, 12, 24 and 48 weeks after ART initiation. We performed advanced lipid phenotyping using nuclear magnetic resonance spectroscopy (Liposcience, Raleigh, NC, USA) for lipid particle size and number, and examined high-density lipoprotein (HDL) function measuring reverse cholesterol transport using J774 macrophages.
  
  
  
  We report significant increases in total cholesterol (13 mg/dl; P<0.001) and low-density lipoprotein (LDL; 8 mg/dl; P=0.03), with no change in triglycerides and without an increase in LDL particle number (P>0.1 all time points). HDL levels were increased over baseline levels at all time points (P<0.003), but reached a peak at week 12 and subsequently declined. HDL particle numbers also increased from baseline (P<0.002) and HDL function improved at week 48 (7% increase in efflux capacity; P<0.001). Oxidized LDL (oxLDL) levels decreased by week 12, but rose subsequently, and were not different from baseline at later time points.
  
  
  
  HDL increases were associated with increases in beneficial HDL particles and HDL cholesterol efflux capacity, which may reduce future CVD events. Persistent inflammation in these HIV+ participants, may be a cause or consequence of oxLDL levels, and may contribute to declining levels of HDL over time. Clinicaltrials.gov NCT00660972.
authors.affiliation: School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Ohio State University, Columbus, OH, USA.
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Funderburg
authors.affiliation: National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
authors.forename: Dihua
authors.initials: D
authors.lastname: Xu
authors.affiliation: National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Playford
authors.affiliation: National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
authors.forename: Aditya A
authors.initials: AA
authors.lastname: Joshi
authors.affiliation: Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Adriana
authors.initials: A
authors.lastname: Andrade
authors.affiliation: Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Kuritzkes
authors.affiliation: Center for AIDS Research, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Lederman
authors.affiliation: National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
authors.forename: Nehal N
authors.initials: NN
authors.lastname: Mehta
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001693:Biological Transport, Active / Q000187:drug effects; D008076:Cholesterol, HDL / Q000097:blood*; D000068679:Emtricitabine / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008077:Lipoproteins, LDL / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D000068898:Raltegravir Potassium / Q000627:therapeutic use*; D000068698:Tenofovir / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D008076:Cholesterol, HDL; D008077:Lipoproteins, LDL; D012367:RNA, Viral; C099252:oxidized low density lipoprotein; D000068898:Raltegravir Potassium; D000068698:Tenofovir; D000068679:Emtricitabine