(Circulation. 1999;100:700-705.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Atherogenic Dyslipidemia in HIV-Infected Individuals Treated With Protease Inhibitors
From the Division of Infectious Diseases (D.P., A.T., P.H., M.P.G.), Department of Pediatrics (J.-J.C.), Division of Endocrinology (M.J.R.), Department of Medicine (P.N., V.M.), and Medical Policlinic (R.D.), CHUV University Hospital, Lausanne, Switzerland; the Swiss HIV Cohort Study (P.S.); and Northwest Lipid Research Laboratories, University of Washington (S.M.M.), Seattle, Wash.
Correspondence to Vincent Mooser, MD, Department of Medicine, BH 19-135, CHUV University Hospital, CH-1011 CHUV Lausanne, Switzerland. E-mail vincent.mooser{at}hola.hospvd.ch
Background—Administration of protease inhibitors (PIs) to HIV-infected individuals has been associated with hyperlipidemia. In this study, we characterized the lipoprotein profile in subjects receiving ritonavir, indinavir, or nelfinavir, alone or in combination with saquinavir.
Methods and Results—Plasma lipoprotein levels were quantified in 93 HIV-infected adults receiving PIs. Comparison was done with pretreatment values and with 28 nonPI-treated HIV-infected subjects. An elevation in plasma cholesterol levels was observed in all PI-treated groups but was more pronounced for ritonavir (2.0±0.3 mmol/L [mean±SEM], n=46, versus 0.1±0.2 mmol/L in nonPI treated group, P<0.001) than for indinavir (0.8±0.2 mmol/L, n=26, P=0.03) or nelfinavir (1.2±0.2 mmol/L, n=21, P=0.01). Administration of ritonavir, but not indinavir or nelfinavir, was associated with a marked elevation in plasma triglyceride levels (1.83±0.46 mmol/L, P=0.002). Plasma HDL-cholesterol levels remained unchanged. Combination of ritonavir or nelfinavir with saquinavir did not further elevate plasma lipid levels. A 48% increase in plasma levels of lipoprotein(a) was detected in PI-treated subjects with pretreatment Lp(a) values >20 mg/dL. Similar changes in plasma lipid levels were observed in 6 children receiving ritonavir.
Conclusions—Administration of PIs to HIV-infected individuals is associated with a marked, compound-specific dyslipidemia. The risk of pancreatitis and premature atherosclerosis due to PI-associated dyslipidemia remains to be established.
Key Words: AIDS • atherosclerosis • drugs • hyperlipoproteinemia • lipoproteins
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