Abstract 680: Antiretroviral Therapy in HIV-Positive Patients Results in a Pro-Atherogenic Postprandial Pattern with Increased Lipoprotein Remnant Cholesterol Levels
Background: Increased levels of postprandial triglycerides (TG) and remnant like particles (RLP) are associated with cardiovascular disease. HIV/Highly Active Antiretroviral Treatment (HAART) results in a dyslipidemic pattern, although the relative contribution of HIV infection vs. HAART has not been clarified. There is limited information on postprandial lipemia across HAART regimens in HIV-positive patients.
Objective: We evaluated whether postprandial lipemia differed in HIV-positive patients with or without different types of antiretroviral therapy.
Design: A standardized high fat load was administered to 28 subjects: 11 HIV-positive subjects receiving protease inhibitors (PI), 10 HIV-positive subjects receiving nonnucleoside reverse transcriptase inhibitors (NNRTI) and 7 HIV-positive subjects not receiving HAART (Naïve). We measured lipid, lipoprotein, RLP-cholesterol, nonesterified fatty acids and insulin concentrations at baseline, and during a 10-h postprandial period.
Results: Baseline fasting TG levels did not differ among the three groups. The postprandial TG concentration curves were similar in the NNRTI and Naïve groups, peaking at 3 to 5-hrs. The PI group had a significantly higher peak TG level (P<0.05) compared to other two groups, but the postprandial area under the curve (AUCs) did not differ between the three HIV groups. Both HAART groups (NNRTI and PI) had a significantly higher postprandial RLP-C response at 3–10 hrs (P<0.05) than the Naïve group. The RLP-C AUCs was higher in PI and NNRTI subjects (111 mg/dl·hr for both) compared to Naïve subjects (59 mg/dl·hr). There were no differences in postprandial insulin, nonesterified fatty acids, total, LDL or HDL cholesterol levels among the three groups.
Conclusions: Our study design allowed us to address the effect of HAART vs. no HAART as well as the effect of specific HAART regimens on the postprandial response in HIV-positive subjects. Irrespective of regimen, HAART treatment resulted in a higher postprandial RLP-C AUC, while no difference in postprandial TG AUC was found between the three groups. Thus, during HIV conditions, HAART treatment resulted in a pro-atherogenic pattern, with a relative increase in remnant lipoproteins.