Human Immunodeficiency Virus

Higher Rate of Dyslipidemia Among Women Living With HIV

Bradley van Paridon
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Approximately 50% of people with HIV have dyslipidemia.3 Common lipid disorders in treated or untreated patients are elevated triglyceride levels and decreased levels of total, high-density lipoprotein, and low-density lipoprotein cholesterol.3,8 Studies consistently associate ART with lipid changes, which may be a direct effect of ART or may result from viral suppression.3,6,8,9 Typical onset of dyslipidemia is within 3 months of starting ART.8 The PIs most likely to induce dyslipidemia are lopinavir, ritonavir, fosamprenavir, and tipranavir; whereas, atazanavir and darunavir are less likely to cause dyslipidemia.3 The non-NRTI efavirenz poses a greater risk for dyslipidemia than the non-NRTIs rilpivirine, etravirine, and nevirapine.3 Older NRTIs affected lipid levels adversely but are rarely used, and the newer NRTIs tenofovir and abacavir may even improve lipid levels.3 Raltegravir and dolutegravir are integrase strand transfer inhibitors, which tend to be lipid neutral and are preferred first-line agents.3

Approximately 50% of people with HIV have dyslipidemia.3 Common lipid disorders in treated or untreated patients are elevated triglyceride levels and decreased levels of total, high-density lipoprotein, and low-density lipoprotein cholesterol.3,8 Studies consistently associate ART with lipid changes, which may be a direct effect of ART or may result from viral suppression.3,6,8,9 Typical onset of dyslipidemia is within 3 months of starting ART.8

The PIs most likely to induce dyslipidemia are lopinavir, ritonavir, fosamprenavir, and tipranavir; whereas, atazanavir and darunavir are less likely to cause dyslipidemia.3 The non-NRTI efavirenz poses a greater risk for dyslipidemia than the non-NRTIs rilpivirine, etravirine, and nevirapine.3 Older NRTIs affected lipid levels adversely but are rarely used, and the newer NRTIs tenofovir and abacavir may even improve lipid levels.3 Raltegravir and dolutegravir are integrase strand transfer inhibitors, which tend to be lipid neutral and are preferred first-line agents.3

Despite relatively young ages, a significantly greater percentage of women living with HIV had dyslipidemia than did controls.

Despite relatively young ages, a significantly greater percentage of women living with HIV had dyslipidemia compared with those who do not have the infection, according to data published in HIV Medicine.

While antiretrovirals have increased the lifespan of people living with HIV, data have highlighted the effects of early comorbidities related to aging. There have been few studies that investigated the prevalence of dyslipidemia in women living with HIV. Investigators therefore used the Children and Women: Antiretrovirals and Markers of Aging (CARMA) cohort to explore the prevalence of cardiometabolic abnormalities among women with HIV and HIV-negative controls.

Researchers conducted a prospective, cross-sectional analysis of data from 289 nonpregnant women, of whom 156 had HIV and 133 did not, aged from 12 to 69 years. The investigators used self-report, anthropometrics, chart review and laboratory data to determine Framingham risk score (FRS) and the prevalence’s of hypertension, diabetes, metabolic syndrome and dyslipidemia. Leukocyte telomere length and blood mitochondrial DNA content was used to determine cellular aging.

The median age for participants in the HIV-positive and HIV-negative groups was 43.5 years and 46.2 years, respectively. HIV-infection status was associated with dyslipidemia (odds ratio [OR], 2.89; 95% CI, 1.69–5.01). It was not, however, associated with diabetes, higher FRS, hypertension or metabolic syndrome. The women in the HIV-positive group were less likely to be menopausal or use alcohol, and more often had hepatitis C virus infection or a current or past smoking history. In terms of associations between cardiometabolic abnormalities and markers of cellular aging, only lower mitochondrial DNA content was associated with metabolic syndrome.

The results of the study were strengthened by a local control group that shared many risk factors for cardiovascular and metabolic disease with those living with HIV. The inclusion of a broad range of ages among participants was also a strength, which allowed for an examination of the effect of HIV while adjusting for age. However, there were several limitations, including, an inability to determine causality due to the cross-sectional study design. Investigators also noted that sample sizes may have limited their ability to detect small between group differences, specifically for less prevalent conditions. Finally, the investigation was limited to current use standards of care in the combination antiretroviral therapies, meaning inferences about specific antiretroviral agents could not be made.

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Result also demonstrated that in this cohort of nonpregnant women, dyslipidemia was significantly more prevalent among women with HIV and among tobacco smokers. There were no other significant differences between women with HIV and controls in terms of other cardiovascular risk factors and metabolic abnormalities.

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According to investigators, this work highlights the importance of smoking cessation interventions and aggressive control of lipids for this population as well as the need for studies that examine post-menopausal women longitudinally to explore long-term outcomes of dyslipidemia as they age.

Reference

Russell E, Albert A, Côté H, et al. Rate of dyslipidemia higher among women living with HIV: A comparison of metabolic and cardiovascular health in a cohort to study aging in HIV [published online March 13 2020]. HIV Med. doi:10.1111/hiv.12843

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