Lipoprotein(a) and HIV: Allele-Specific Apolipoprotein(a) Levels Predict Carotid Intima-Media Thickness in HIV-Infected Young Women in the Women's Interagency HIV Study.
In the general population, lipoprotein(a) [Lp(a)] has been established as an independent causal risk factor for cardiovascular disease. Lp(a) levels are to a major extent regulated by a size polymorphism in the apolipoprotein(a) [apo(a)] gene. The roles of Lp(a)/apo(a) in human immunodeficiency virus (HIV)-related elevated cardiovascular disease risk remain unclear.



The associations between total plasma Lp(a) level, allele-specific apo(a) level, an Lp(a) level carried by individual apo(a) alleles, and common carotid artery intima-media thickness were assessed in 150 HIV-infected and 100 HIV-uninfected women in the WIHS (Women's Interagency HIV Study). Linear regression analyses with and without adjustments were used. The cohort was young (mean age, ≈31 years), with the majority being Blacks (≈70%). The prevalence of a small size apo(a) (≤22 Kringle repeats) or a high Lp(a) level (≥30 mg/dL) was similar by HIV status. Total plasma Lp(a) level (P=0.029) and allele-specific apo(a) level carried by the smaller apo(a) sizes (P=0.022) were significantly associated with carotid artery intima-media thickness in the HIV-infected women only. After accounting for confounders (age, race, smoking, body mass index, blood pressure, hepatitis C virus coinfection, menopause, plasma lipids, treatment status, CD4+T cell count, and HIV/RNA viral load), the association remained significant for both Lp(a) (P=0.035) and allele-specific apo(a) level carried by the smaller apo(a) sizes (P=0.010) in the HIV-infected women. Notably, none of the other lipids/lipoproteins was associated with carotid artery intima-media thickness.



Lp(a) and allele-specific apo(a) levels predict carotid artery intima-media thickness in HIV-infected young women. Further research is needed to identify underlying mechanisms of an increased Lp(a) atherogenicity in HIV infection.
From the Departments of Internal Medicine (B.E., E.A., W.Z., L.B.) and Public Health Sciences (C.-S.L.), University of California, Davis; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (R. Kaplan); Department of Cardiovascular Disease, SUNY Downstate Medical Center, Brooklyn, NY (J.L.); Department of Family Medicine, Georgetown University Medical Center, Washington, DC (D.M.); Department Preventive Medicine, University of Southern California, Los Angeles (R. Karim); Department of Oral and Maxillofacial Surgery, New York University (B.A.); Stroger Hospital, Cook County Bureau of Health Services, Chicago, IL (M.C.); Division of Geriatric Medicine/Gerontology, University of Mississippi Medical Center, Jackson (K.B.); Miami Center for AIDS Research, University of Miami, FL (S.P.); Department of Medicine, Infectious Diseases, Emory School of Medicine, Atlanta, GA (I.O.); Division of Infectious Diseases, University of North Carolina, Chapel Hill (A.A.A.); and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.G.).
Byambaa
B
Enkhmaa
From the Departments of Internal Medicine (B.E., E.A., W.Z., L.B.) and Public Health Sciences (C.-S.L.), University of California, Davis; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (R. Kaplan); Department of Cardiovascular Disease, SUNY Downstate Medical Center, Brooklyn, NY (J.L.); Department of Family Medicine, Georgetown University Medical Center, Washington, DC (D.M.); Department Preventive Medicine, University of Southern California, Los Angeles (R. Karim); Department of Oral and Maxillofacial Surgery, New York University (B.A.); Stroger Hospital, Cook County Bureau of Health Services, Chicago, IL (M.C.); Division of Geriatric Medicine/Gerontology, University of Mississippi Medical Center, Jackson (K.B.); Miami Center for AIDS Research, University of Miami, FL (S.P.); Department of Medicine, Infectious Diseases, Emory School of Medicine, Atlanta, GA (I.O.); Division of Infectious Diseases, University of North Carolina, Chapel Hill (A.A.A.); and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.G.).
Erdembileg
E
Anuurad
From the Departments of Internal Medicine (B.E., E.A., W.Z., L.B.) and Public Health Sciences (C.-S.L.), University of California, Davis; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (R. Kaplan); Department of Cardiovascular Disease, SUNY Downstate Medical Center, Brooklyn, NY (J.L.); Department of Family Medicine, Georgetown University Medical Center, Washington, DC (D.M.); Department Preventive Medicine, University of Southern California, Los Angeles (R. Karim); Department of Oral and Maxillofacial Surgery, New York University (B.A.); Stroger Hospital, Cook County Bureau of Health Services, Chicago, IL (M.C.); Division of Geriatric Medicine/Gerontology, University of Mississippi Medical Center, Jackson (K.B.); Miami Center for AIDS Research, University of Miami, FL (S.P.); Department of Medicine, Infectious Diseases, Emory School of Medicine, Atlanta, GA (I.O.); Division of Infectious Diseases, University of North Carolina, Chapel Hill (A.A.A.); and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.G.).
Wei
W
Zhang
From the Departments of Internal Medicine (B.E., E.A., W.Z., L.B.) and Public Health Sciences (C.-S.L.), University of California, Davis; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (R. Kaplan); Department of Cardiovascular Disease, SUNY Downstate Medical Center, Brooklyn, NY (J.L.); Department of Family Medicine, Georgetown University Medical Center, Washington, DC (D.M.); Department Preventive Medicine, University of Southern California, Los Angeles (R. Karim); Department of Oral and Maxillofacial Surgery, New York University (B.A.); Stroger Hospital, Cook County Bureau of Health Services, Chicago, IL (M.C.); Division of Geriatric Medicine/Gerontology, University of Mississippi Medical Center, Jackson (K.B.); Miami Center for AIDS Research, University of Miami, FL (S.P.); Department of Medicine, Infectious Diseases, Emory School of Medicine, Atlanta, GA (I.O.); Division of Infectious Diseases, University of North Carolina, Chapel Hill (A.A.A.); and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.G.).
Chin-Shang
CS
Li
From the Departments of Internal Medicine (B.E., E.A., W.Z., L.B.) and Public Health Sciences (C.-S.L.), University of California, Davis; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (R. Kaplan); Department of Cardiovascular Disease, SUNY Downstate Medical Center, Brooklyn, NY (J.L.); Department of Family Medicine, Georgetown University Medical Center, Washington, DC (D.M.); Department Preventive Medicine, University of Southern California, Los Angeles (R. Karim); Department of Oral and Maxillofacial Surgery, New York University (B.A.); Stroger Hospital, Cook County Bureau of Health Services, Chicago, IL (M.C.); Division of Geriatric Medicine/Gerontology, University of Mississippi Medical Center, Jackson (K.B.); Miami Center for AIDS Research, University of Miami, FL (S.P.); Department of Medicine, Infectious Diseases, Emory School of Medicine, Atlanta, GA (I.O.); Division of Infectious Diseases, University of North Carolina, Chapel Hill (A.A.A.); and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.G.).
Robert
R
Kaplan
From the Departments of Internal Medicine (B.E., E.A., W.Z., L.B.) and Public Health Sciences (C.-S.L.), University of California, Davis; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (R. Kaplan); Department of Cardiovascular Disease, SUNY Downstate Medical Center, Brooklyn, NY (J.L.); Department of Family Medicine, Georgetown University Medical Center, Washington, DC (D.M.); Department Preventive Medicine, University of Southern California, Los Angeles (R. Karim); Department of Oral and Maxillofacial Surgery, New York University (B.A.); Stroger Hospital, Cook County Bureau of Health Services, Chicago, IL (M.C.); Division of Geriatric Medicine/Gerontology, University of Mississippi Medical Center, Jackson (K.B.); Miami Center for AIDS Research, University of Miami, FL (S.P.); Department of Medicine, Infectious Diseases, Emory School of Medicine, Atlanta, GA (I.O.); Division of Infectious Diseases, University of North Carolina, Chapel Hill (A.A.A.); and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.G.).
Jason
J
Lazar
From the Departments of Internal Medicine (B.E., E.A., W.Z., L.B.) and Public Health Sciences (C.-S.L.), University of California, Davis; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (R. Kaplan); Department of Cardiovascular Disease, SUNY Downstate Medical Center, Brooklyn, NY (J.L.); Department of Family Medicine, Georgetown University Medical Center, Washington, DC (D.M.); Department Preventive Medicine, University of Southern California, Los Angeles (R. Karim); Department of Oral and Maxillofacial Surgery, New York University (B.A.); Stroger Hospital, Cook County Bureau of Health Services, Chicago, IL (M.C.); Division of Geriatric Medicine/Gerontology, University of Mississippi Medical Center, Jackson (K.B.); Miami Center for AIDS Research, University of Miami, FL (S.P.); Department of Medicine, Infectious Diseases, Emory School of Medicine, Atlanta, GA (I.O.); Division of Infectious Diseases, University of North Carolina, Chapel Hill (A.A.A.); and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.G.).
Dan
D
Merenstein
From the Departments of Internal Medicine (B.E., E.A., W.Z., L.B.) and Public Health Sciences (C.-S.L.), University of California, Davis; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (R. Kaplan); Department of Cardiovascular Disease, SUNY Downstate Medical Center, Brooklyn, NY (J.L.); Department of Family Medicine, Georgetown University Medical Center, Washington, DC (D.M.); Department Preventive Medicine, University of Southern California, Los Angeles (R. Karim); Department of Oral and Maxillofacial Surgery, New York University (B.A.); Stroger Hospital, Cook County Bureau of Health Services, Chicago, IL (M.C.); Division of Geriatric Medicine/Gerontology, University of Mississippi Medical Center, Jackson (K.B.); Miami Center for AIDS Research, University of Miami, FL (S.P.); Department of Medicine, Infectious Diseases, Emory School of Medicine, Atlanta, GA (I.O.); Division of Infectious Diseases, University of North Carolina, Chapel Hill (A.A.A.); and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.G.).
Roksana
R
Karim
From the Departments of Internal Medicine (B.E., E.A., W.Z., L.B.) and Public Health Sciences (C.-S.L.), University of California, Davis; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (R. Kaplan); Department of Cardiovascular Disease, SUNY Downstate Medical Center, Brooklyn, NY (J.L.); Department of Family Medicine, Georgetown University Medical Center, Washington, DC (D.M.); Department Preventive Medicine, University of Southern California, Los Angeles (R. Karim); Department of Oral and Maxillofacial Surgery, New York University (B.A.); Stroger Hospital, Cook County Bureau of Health Services, Chicago, IL (M.C.); Division of Geriatric Medicine/Gerontology, University of Mississippi Medical Center, Jackson (K.B.); Miami Center for AIDS Research, University of Miami, FL (S.P.); Department of Medicine, Infectious Diseases, Emory School of Medicine, Atlanta, GA (I.O.); Division of Infectious Diseases, University of North Carolina, Chapel Hill (A.A.A.); and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.G.).
Brad
B
Aouizerat
From the Departments of Internal Medicine (B.E., E.A., W.Z., L.B.) and Public Health Sciences (C.-S.L.), University of California, Davis; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (R. Kaplan); Department of Cardiovascular Disease, SUNY Downstate Medical Center, Brooklyn, NY (J.L.); Department of Family Medicine, Georgetown University Medical Center, Washington, DC (D.M.); Department Preventive Medicine, University of Southern California, Los Angeles (R. Karim); Department of Oral and Maxillofacial Surgery, New York University (B.A.); Stroger Hospital, Cook County Bureau of Health Services, Chicago, IL (M.C.); Division of Geriatric Medicine/Gerontology, University of Mississippi Medical Center, Jackson (K.B.); Miami Center for AIDS Research, University of Miami, FL (S.P.); Department of Medicine, Infectious Diseases, Emory School of Medicine, Atlanta, GA (I.O.); Division of Infectious Diseases, University of North Carolina, Chapel Hill (A.A.A.); and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.G.).
Mardge
M
Cohen
From the Departments of Internal Medicine (B.E., E.A., W.Z., L.B.) and Public Health Sciences (C.-S.L.), University of California, Davis; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (R. Kaplan); Department of Cardiovascular Disease, SUNY Downstate Medical Center, Brooklyn, NY (J.L.); Department of Family Medicine, Georgetown University Medical Center, Washington, DC (D.M.); Department Preventive Medicine, University of Southern California, Los Angeles (R. Karim); Department of Oral and Maxillofacial Surgery, New York University (B.A.); Stroger Hospital, Cook County Bureau of Health Services, Chicago, IL (M.C.); Division of Geriatric Medicine/Gerontology, University of Mississippi Medical Center, Jackson (K.B.); Miami Center for AIDS Research, University of Miami, FL (S.P.); Department of Medicine, Infectious Diseases, Emory School of Medicine, Atlanta, GA (I.O.); Division of Infectious Diseases, University of North Carolina, Chapel Hill (A.A.A.); and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.G.).
Kenneth
K
Butler
From the Departments of Internal Medicine (B.E., E.A., W.Z., L.B.) and Public Health Sciences (C.-S.L.), University of California, Davis; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (R. Kaplan); Department of Cardiovascular Disease, SUNY Downstate Medical Center, Brooklyn, NY (J.L.); Department of Family Medicine, Georgetown University Medical Center, Washington, DC (D.M.); Department Preventive Medicine, University of Southern California, Los Angeles (R. Karim); Department of Oral and Maxillofacial Surgery, New York University (B.A.); Stroger Hospital, Cook County Bureau of Health Services, Chicago, IL (M.C.); Division of Geriatric Medicine/Gerontology, University of Mississippi Medical Center, Jackson (K.B.); Miami Center for AIDS Research, University of Miami, FL (S.P.); Department of Medicine, Infectious Diseases, Emory School of Medicine, Atlanta, GA (I.O.); Division of Infectious Diseases, University of North Carolina, Chapel Hill (A.A.A.); and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.G.).
Savita
S
Pahwa
From the Departments of Internal Medicine (B.E., E.A., W.Z., L.B.) and Public Health Sciences (C.-S.L.), University of California, Davis; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (R. Kaplan); Department of Cardiovascular Disease, SUNY Downstate Medical Center, Brooklyn, NY (J.L.); Department of Family Medicine, Georgetown University Medical Center, Washington, DC (D.M.); Department Preventive Medicine, University of Southern California, Los Angeles (R. Karim); Department of Oral and Maxillofacial Surgery, New York University (B.A.); Stroger Hospital, Cook County Bureau of Health Services, Chicago, IL (M.C.); Division of Geriatric Medicine/Gerontology, University of Mississippi Medical Center, Jackson (K.B.); Miami Center for AIDS Research, University of Miami, FL (S.P.); Department of Medicine, Infectious Diseases, Emory School of Medicine, Atlanta, GA (I.O.); Division of Infectious Diseases, University of North Carolina, Chapel Hill (A.A.A.); and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.G.).
Igho
I
Ofotokun
From the Departments of Internal Medicine (B.E., E.A., W.Z., L.B.) and Public Health Sciences (C.-S.L.), University of California, Davis; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (R. Kaplan); Department of Cardiovascular Disease, SUNY Downstate Medical Center, Brooklyn, NY (J.L.); Department of Family Medicine, Georgetown University Medical Center, Washington, DC (D.M.); Department Preventive Medicine, University of Southern California, Los Angeles (R. Karim); Department of Oral and Maxillofacial Surgery, New York University (B.A.); Stroger Hospital, Cook County Bureau of Health Services, Chicago, IL (M.C.); Division of Geriatric Medicine/Gerontology, University of Mississippi Medical Center, Jackson (K.B.); Miami Center for AIDS Research, University of Miami, FL (S.P.); Department of Medicine, Infectious Diseases, Emory School of Medicine, Atlanta, GA (I.O.); Division of Infectious Diseases, University of North Carolina, Chapel Hill (A.A.A.); and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.G.).
Adaora A
AA
Adimora
From the Departments of Internal Medicine (B.E., E.A., W.Z., L.B.) and Public Health Sciences (C.-S.L.), University of California, Davis; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (R. Kaplan); Department of Cardiovascular Disease, SUNY Downstate Medical Center, Brooklyn, NY (J.L.); Department of Family Medicine, Georgetown University Medical Center, Washington, DC (D.M.); Department Preventive Medicine, University of Southern California, Los Angeles (R. Karim); Department of Oral and Maxillofacial Surgery, New York University (B.A.); Stroger Hospital, Cook County Bureau of Health Services, Chicago, IL (M.C.); Division of Geriatric Medicine/Gerontology, University of Mississippi Medical Center, Jackson (K.B.); Miami Center for AIDS Research, University of Miami, FL (S.P.); Department of Medicine, Infectious Diseases, Emory School of Medicine, Atlanta, GA (I.O.); Division of Infectious Diseases, University of North Carolina, Chapel Hill (A.A.A.); and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.G.).
Elizabeth
E
Golub
From the Departments of Internal Medicine (B.E., E.A., W.Z., L.B.) and Public Health Sciences (C.-S.L.), University of California, Davis; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (R. Kaplan); Department of Cardiovascular Disease, SUNY Downstate Medical Center, Brooklyn, NY (J.L.); Department of Family Medicine, Georgetown University Medical Center, Washington, DC (D.M.); Department Preventive Medicine, University of Southern California, Los Angeles (R. Karim); Department of Oral and Maxillofacial Surgery, New York University (B.A.); Stroger Hospital, Cook County Bureau of Health Services, Chicago, IL (M.C.); Division of Geriatric Medicine/Gerontology, University of Mississippi Medical Center, Jackson (K.B.); Miami Center for AIDS Research, University of Miami, FL (S.P.); Department of Medicine, Infectious Diseases, Emory School of Medicine, Atlanta, GA (I.O.); Division of Infectious Diseases, University of North Carolina, Chapel Hill (A.A.A.); and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.G.). lberglund@ucdavis.edu.
Lars
L
Berglund
D000328:Adult; D000483:Alleles; D053241:Apoprotein(a) / Q000097:blood* / Q000235:genetics*; D015415:Biomarkers / Q000097:blood; D002340:Carotid Artery Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology* / Q000235:genetics; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging*; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000235:genetics; D006801:Humans; D016014:Linear Models; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States; D055815:Young Adult
D015415:Biomarkers; D053241:Apoprotein(a)
antiretroviral therapy; apo(a) size, HIV treatment; apolipoprotein(a); cardiovascular risk; carotid artery intima–media thickness; lipoprotein(a)