Evaluation of Lipid Profile and Intima Media Thickness in Antiretroviral-Experienced HIV-Infected Patients Treated with Protease Inhibitor-Based Regimens versus Protease Inhibitor-Sparing Regimens

Abstract

Background: Antiretroviral therapy has increasingly improved management of HIV infection, ensuring long-term efficacy and tolerability. Each class of antiretrovirals has, however, different characteristics and different tolerability profiles. The literature data show that protease inhibitors (PIs) are associated with a higher incidence of dyslipidemia. The aim of our study was to evaluate whether patients treated with PIs have both greater dyslipidemia and increased intima media thickness (IMT) and atheromatous plaques compared to patients treated without PIs. Materials and Methods: A total of 110 HIV-experienced patients screened with Doppler ultrasonography of the supra-aortic trunks in December 2019 were enrolled in a retrospective cross-sectional observational study. Patients were divided into two groups: 59 in the PI-based group, treated with PIs, and 51 in the PI-sparing group. In the two groups, we evaluated lipids, cardiovascular risk factors (smoking, BMI, age, hypertension), increased pathological IMT (a value > 1 mm), and possible atheromatous plaque. Results: Serum LDL (p 0.04) and percentage of patients with hypercholesterolemia (p 0.03) were higher in the PI-based than in the PI-sparing group. Doppler data showed a trend in increase of IMT > 1 in the PI-based group, which appeared statistically significant for the section of the left common carotid artery (p 0.03). However, in multivariate logistic regression models, none of the evaluated variables were significantly associated with IMT > 1. Conclusions: Our real-life data show that patients treated with PIs have a trend of developing both greater dyslipidemia and increased pathological IMT and atheromatous plaques These findings may be useful to optimize antiretrovirals for patients with cardiovascular risk factors.

Evaluation of Myo-Intimal Media Thickness and Atheromatous Plaques in People Living with HIV from the Archiprevaleat Cohort vs. HIV-Negative Subjects

“…Only 30% of subjects treated with PI were receiving a ritonavir-containing regimen at baseline. In our recent study, we evaluated the lipid profile and cIMT in antiretroviral-experienced HIV-positive patients treated with PI-based versus PI-sparing regimens [13]. Our real-life data show that patients treated with PI have a tendency to develop both increased dyslipidemia and increased pathological IMT and atheromatous plaques.…”

Pathophysiology and Clinical Management of Dyslipidemia in People Living with HIV: Sailing through Rough Seas

“…In general, PI-based regimens have a trend to develop greater atherosclerosis compared to non-PI-based regimens, as demonstrated by the increase in the intima media thickness (IMT) and the development of atheromatous plaques. More specifically, PIs inhibit lipolysis by altering lipoprotein lipase (LPL) activity, resulting in reduced TG uptake in adipocytes and elevated plasma TG levels [72,73]. Furthermore, they inhibit the nuclear localization of sterol response element binding protein-1 (SREBP-1) in adipocytes, resulting in the downregulation of PPARγ, impaired adipocyte differentiation, and insufficient lipid removal from circulation, while concomitantly promoting the nuclear localization of SREBP-1 in hepatocytes, resulting in excessive fatty acids synthesis [74,75].…”

Human Immunodeficiency Virus as a Risk Factor for Cardiovascular Disease

“…In contrast, PIs are generally considered to have unfavorable effects in terms of cardiovascular risk. The mechanisms responsible include the triggering of reactive oxygen species production, impaired mitochondrial function, and ubiquitin-proteasome system dysregulation, factors that can in turn initiate transcriptional changes that contribute to the perturbation of lipid metabolism [ 124 ].…”