Cardiovascular disease risk varies with HIV subgroup

The ability of lipids to predict risk for cardiovascular disease (CVD) may be weakened in women who are infected with HIV, report researchers.

The predictive ability of lipids may differ across subgroups of the HIV-infected population, and in those who are untreated relatively late in infection, lipids may be of limited value in identifying patients who are at increased CVD risk.

Initiation of highly active antiretroviral therapy (HAART) in HIV-infected people has previously been shown to increase lipid levels compared to pretreatment levels, and dyslipidemia associated with HAART has also been shown to increase CVD risk, note Robert Kaplan (Albert Einstein College of Medicine, New York, USA) and colleagues.

As reported in Atherosclerosis, the team studied the association of lipid levels with subclinical atherosclerosis in a study of 1827 women (1305 HIV-infected, 522 HIV-uninfected) who participated in the Women Interagency HIV Study.

The team found that HIV-infected women who were treated with ART (n=836) had significantly higher levels of high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, total cholesterol (TC), and nonHDL cholesterol than those who were untreated (n=469).

The treated women also had significantly higher levels of TC and nonHDL cholesterol than those who were not infected with HIV (n=522).

Among the uninfected women, higher TC, LDL cholesterol, and nonHDL cholesterol were all significantly associated with higher carotid intima-media thickness (CIMT).

In addition, in the infected women who were ART-treated, higher LDL cholesterol was significantly associated with increased CIMT and higher nonHDL cholesterol also tended to be associated with increased CIMT.

However, of the 469 infected women who were not treated with ART, there was no significant association of lipid measures with CIMT.

"Among HIV-infected women, we showed that hyperlipidemia has the strongest association with atherosclerosis in women on treatment," say Kaplan and colleagues.

"From a clinical perspective, physicians should recognize that the ability of lipids to predict CVD risk may be weaker in HIV-infected women than in HIV-uninfected women," they conclude.

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