Treatment of HIV infection with a raltegravir-based regimen increases LDL levels, but improves HDL cholesterol efflux capacity
Funderburg NT, Xu D, Playford MP, Joshi AA, Andrade A, Kuritzkes DR, Lederman MM, Mehta NN.
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-naïve participants in a substudy of A5248, a single-arm study of raltegravir (RAL), 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 (NMR) spectroscopy (Liposcience, Raleigh, NC) for lipid particle size and number, and examined HDL function measuring reverse cholesterol transport using J774 macrophages.
We report significant increases in total cholesterol (TC, 13 mg/dL; p<0.001) and low density lipoprotein (LDL, 8 mg/dL; p=0.03), with no change in triglycerides (TGs) and without an increase in LDL-particle number (p>0.1 all timepoints). High density lipoprotein (HDL) levels were increased over baseline levels at all timepoints (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 timepoints.
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.
Antivir Ther. 2016 Oct 14. doi: 10.3851/IMP3091. [Epub ahead of print]