High‐Density Lipoprotein Particles and Markers of Inflammation and Thrombotic Activity in Patients with Untreated HIV Infection

Abstract

Background Untreated HIV infection is associated with changes in blood lipids, inflammation, thrombotic activity, and increased risk for CVD. Methods We studied high-density lipoprotein particle (HDLp) concentrations and inflammatory (hsCRP, IL-6), endothelial activation (E-selectin, sICAM-1) and thrombotic (fibrinogen and D-dimer) biomarkers in 32 untreated HIV-infected and 29 uninfected persons. Differences in blood lipids and biomarkers by HIV status were examined before and after adjustment for: age, gender, race/ethnicity, smoking status, BMI, and hepatitis C. Results HIV-infected, versus uninfected, participants had lower HDLc (−26%) and total (−21%), large (−50%)and small HDLp (−20%; p≤0.01 for all), but not medium HDLp. A trend was present for higher total cholesterol (p=0.15) and triglycerides (p=0.11) with HIV infection. Levels of IL-6, sICAM-1 and D-dimer were 65–70% higher in HIV-infected participants (p≤0.02 for all). Covariate adjustment did not diminish these associations. For HIV-infected participants, total and small HDLp (respectively) tended to correlate inversely with levels of IL-6 (p=0.08 and p=0.02), sICAM-1 (p<0.01 for both) and D-dimer (p=0.03 and p<0.01). Conclusions Persons with untreated HIV infection have lower HDLp, primarily large and small HDLp, and higher IL-6, sICAM-1, and D-dimer levels, and the relationship of these markers with risk for HIV-mediated atherosclerotic risk requires further study.

Metabolic Effects of Darunavir/Ritonavir Versus Atazanavir/Ritonavir in Treatment-Naive, HIV Type 1-Infected Subjects over 48 Weeks

“…39 Subjects infected with HIV-1 have increased levels of hs-CRP, TNF alpha (TNF-a), IL-6, d-dimer, and other biomarkers compared with HIV-negative subjects. 2,[40][41][42] These elevations in biomarkers persist even after virologic suppression, likely due to HIV-induced activation of inflammation and coagulation pathways. 2 Levels of TNF-a, IL-6, hs-CRP, and other proinflammatory cytokines are associated with HIV-1 viral load and may predict disease progression, as well as correlate with a higher risk of CVD and all-cause mortality.…”

Increased Risk of Radiographic Emphysema in HIV Is Associated With Elevated Soluble CD14 and Nadir CD4

“…13 Early in the antiretroviral therapy (ART) era, however, increased emphysema was described among individuals with HIV infection who had no prior opportunistic lung infections. 14 HIV infection is associated with chronic infl ammation, endothelial dysfunction, altered coagulation, and immune activation, which are tightly linked to comorbidities and early mortality in HIV, even among those receiving eff ective ART [15][16][17][18][19][20] ; whether emphysema is associated with biomarkers refl ective of these factors is unknown. Th erefore, in the current study, we determined whether HIV infection is a risk factor for radiographic emphysema in the current ART era, characterizing emphysema semiquantitatively on chest CT scans and determining whether diff erences in the severity, distribution, and type of emphysema by HIV exist.…”

HIV-Infected Patients and Potential Impact on Thrombotic Events

“…In this way, HDL possesses anti-inflammatory and antithrombotic properties. A crosssectional study [14] was designed to assess large and small high density lipoprotein particle (HDLp) concentrations in persons with untreated HIV infection. Lower small HDLp (primarily responsible for HDL's anti-inflammatory properties and inhibition of endothelial activation) concentrations and higher IL-6, sICAM-1 and D-dimer levels were found.…”