NEW YORK (Reuters Health) – Determining the low-density lipoprotein particle (LDL-p) concentration in women with HIV doesn’t seem to be worthwhile, as doing so adds little information beyond triglyceride levels in assessing cardiovascular risk, researchers report.
“By contrast,” lead investigators Dr. Phyllis Tien told Reuters Health, “HIV infection remained associated with lower small HDL-particle concentration (which some have also shown to be associated with cardiovascular risk) even after adjustment for standard lipids.”
HIV infection is associated with proatherogenic lipid profiles, note Dr. Tien with the University of California, San Francisco, and colleagues in AIDS online September 24. “Assessment of the concentrations of lipoprotein particles (which transport cholesterol and triglycerides) may provide information regarding CVD risk beyond the standard lipid panel.”
Specifically, greater amounts of small LDL-p and lower small HDL-p have been linked to cardiovascular risk in the general population. However, “Few studies have examined whether HIV and HAART use are associated with lipoprotein particle concentrations after adjusting for standard lipids,” the investigators point out.
To look into this, they analyzed data from the Women’s Interagency HIV Study (WHIS) and quantified lipoprotein particle concentrations in freshly thawed frozen plasma samples using nuclear magnetic resonance spectroscopy from 361 HIV-negative women, 128 HIV-positive women not on HAART, and 588 HIV-positive women on HAART.
The team found that the HIV-infected subjects receiving HAART (but not those not on HAART) had higher levels of small LDL-p than the HIV-uninfected group. However, “triglyceride levels were strongly associated with greater small LDL-p,” and once that was factored in the association between LDL-p and HAART was no longer significant.
As for small HDL-p, levels were lower than normal in women with HIV regardless of HAART status, even after adjusting for triglycerides.
“Our findings suggest that routine testing of LDL-p concentrations will not confer additional information beyond triglycerides and HDL-C levels when assessing CVD risk,” Dr. Tien and colleagues write.
Conversely, it looks like HDL-p concentrations are directly affected by HIV. “Further investigation is needed to examine the role of HDL-p in the link between HIV and CVD in women,” the team concludes.
“In terms of implications for treatment if HDL-p is associated with CVD risk, again I think further study is needed to understand the mechanisms by which HDL-p might be associated with CVD in order to understand targets for intervention,” Dr. Tien added. “A recent study suggested that the association of small HDL-p with CVD events might be mediated through inflammation.”
Reference:
HIV, HAART, and lipoprotein particle concentrations in the Women’s Interagency HIV Study
AIDS 2010;24.
