To explore reasons for the disproportionate metabolic and cardiovascular disease burdens among older HIVinfected persons, we investigated whether associations of CD4 count and HIV viral load (VL) with non-highdensity lipoprotein cholesterol (non-HDL-C) and high-density lipoprotein cholesterol [HDL-C] differed by age. Longitudinal clinical and laboratory data were collected between 2011 and 2016 for HIV-infected outpatients in the DC Cohort study. Using data for patients aged ‡21 years with ‡1 cholesterol result and contemporaneous CD4/VL results, we created multivariable linear regression models with generalized estimating equations. Among 3,912 patients, the median age was 50 years, 78% were male, 76% were non-Hispanic black, 93% were using antiretroviral therapy, 8% had a CD4 count <200 cells/lL, and 18% had an HIV VL ‡200 copies/mL. Overall, CD4 count <200 (vs. >500) cells/lL and VL ‡200 copies/mL were associated with lower non-HDL-C concentrations (p < .01), but associations were more positive with increasing age (CD4-age/VL-age interactions, p < .01). CD4 count <200 cells/lL was associated with lower non-HDL-C among patients aged <50 years [b =-7.8 mg/dL (95% confidence interval, CI:-13.2 to-2.4)] but higher non-HDL-C among patients aged 60-69 years [b = +8.1 mg/dL (95% CI: 0.02-16.2)]. VL ‡200 copies/mL was associated with lower non-HDL-C among patients aged <50 years [b =-3.3 mg/dL (95% CI:-6.7 to 0.1)] but higher non-HDL-C among patients aged ‡70 years [b = +16.0 mg/dL (95% CI:-1.4 to 33.3)], although precision was reduced in age-stratified analyses. Although no age differences were detected for HDL-C, VL ‡200 copies/mL was more strongly associated with lower HDL-C concentrations when CD4 count was <200 cells/lL [b =-7.0 mg/dL (95% CI:-9.7 to-4.3)] versus 200-500 cells/lL [b =-4.2 (95% CI:-5.9 to-2.6)] or >500 cells/lL [b =-2.2 (95% CI:-3.7 to-0.8)] (CD4-VL interaction, p < .01). We detected a novel age-modified relationship between immunosuppression and viremia and atherogenic cholesterol patterns. These findings may contribute to our understanding of the high risk of dyslipidemia observed among persons aging with HIV.
