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doi: 10.1097/QAD.0000000000000026
Clinical Science

HIV/hepatitis C virus coinfection ameliorates the atherogenic lipoprotein abnormalities of HIV infection

Wheeler, Amber L.a,b; Scherzer, Rebeccaa,b; Lee, Danielc; Delaney, Joseph A.C.d; Bacchetti, Petere; Shlipak, Michael G.a,b; Sidney, Stephenf; Grunfeld, Carla,b; Tien, Phyllis C.a,b; for the Study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM)

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Background: Higher levels of small low-density lipoprotein (LDL) and lower levels of high-density lipoprotein (HDL) subclasses have been associated with increased risk of cardiovascular disease. The extent to which HIV infection and HIV/hepatitis C virus (HCV) coinfection are associated with abnormalities of lipoprotein subclasses is unknown.

Methods: Lipoprotein subclasses were measured by nuclear magnetic resonance (NMR) spectroscopy in plasma samples from 569 HIV-infected and 5948 control participants in the Fat Redistribution and Metabolic Change in HIV Infection (FRAM), Coronary Artery Risk Development in Young Adults (CARDIA), and Multi-Ethnic Study of Atherosclerosis (MESA) studies. Multivariable regression was used to estimate the association of HIV and HIV/HCV coinfection with lipoprotein measures with adjustment for demographics, lifestyle factors, and waist-to-hip ratio.

Results: Relative to controls, small LDL levels were higher in HIV-monoinfected persons (+381 nmol/l, P <0.0001), with no increase seen in HIV/HCV coinfection (−16.6 nmol/l). Levels of large LDL levels were lower (−196 nmol/l, P <0.0001) and small HDL were higher (+8.2 μmol/l, P < 0.0001) in HIV monoinfection with intermediate values seen in HIV/HCV coinfection. Large HDL levels were higher in HIV/HCV-coinfected persons relative to controls (+1.70 μmol/l, P <0.0001), whereas little difference was seen in HIV-monoinfected persons (+0.33, P = 0.075). Within HIV-infected participants, HCV was associated independently with lower levels of small LDL (−329 nmol/l, P <0.0001) and small HDL (−4.6 μmol/l, P <0.0001), even after adjusting for demographic and traditional cardiovascular risk factors.

Conclusion: HIV-monoinfected participants had worse levels of atherogenic LDL lipoprotein subclasses compared with controls. HIV/HCV coinfection attenuates these changes, perhaps by altering hepatic factors affecting lipoprotein production and/or metabolism. The effect of HIV/HCV coinfection on atherosclerosis and the clinical consequences of low small subclasses remain to be determined.

© 2014 Lippincott Williams & Wilkins, Inc.


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