Immunosuppression and HIV Viremia Associated with More Atherogenic Lipid Profile in Older People with HIV

Abstract

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.

Contribution of APOA5, APOC3, CETP, ABCA1 and SIK3 genetic variants to hypertriglyceridemia development in Mexican HIV-patients receiving antiretroviral therapy

“…In our study, enrolled HIV patients were predominantly men (93.23%), due to the local HIV epidemic being concentrated in men who have sex with men [28]. In concordance with other studies [29,30], our results suggest that age has an association with the risk of hypertriglyceridemia ( P = 0.0002) among persons with HIV infection. At recruitment, both cases and controls exhibited an adequate immunologic status characterized by T CD4+ cells >500 cel/µL and 78.8% of them had viral suppression, whereas 21.16% has detectable viremia.…”

Relationship between Circulating Inflammatory Monocytes and Cardiovascular Disease Measures of Carotid Intimal Thickness

“…Previous reports demonstrated that coronary atherosclerosis was more common in HIV-infected individuals, and that coronary plaque was larger compared to those of HIV-uninfected individuals 21) . Additionally, immunosuppression and HIV viremia were also associated with more atherogenic lipid profiles in aging individuals with HIV 22) . Our study focused mainly on exploring monocyte subsets as predictive markers for future atherosclerosis in healthy individuals.…”

Weight changes, metabolic syndrome and all‐cause mortality among Asian adults living with HIV

“…Previous reports demonstrated that specific factors of HIV infection, such as immunosuppression and viraemia, were associated with metabolic abnormalities such as dyslipidaemia 24 and insulin resistance. 25 Consistent with other studies, 26,27 low CD4 count, unsuppressed HIV and AIDS events during the follow-up were associated with MetS development in the present study.…”