Lipid Abnormalities and Inflammation in HIV Inflection

Abstract

Infection with the human immunodeficiency virus (HIV), and subsequent treatment with antiretroviral therapy (ART), is often associated with perturbations in lipid profiles. Furthermore, persistent inflammation, in spite of suppression of viral replication by ART, likely contributes to modifications in lipid composition and function, exacerbating risk for development of cardiovascular disease (CVD). Increased levels of several pro-inflammatory lipid species, including oxidized LDL and HDL, have been measured in HIV-infected persons and are associated with markers of immune activation. The mechanisms linked to this bidirectional relationship in which inflammation increases lipid levels and promotes their modification, and these modified lipid species perpetuate inflammatory processes, require further investigation. Treatment with statins and other lifestyle modifications, including improvement in dietary intake and exercise, are critical to reducing CVD risk. Well-designed clinical trials that take into account the complex relationships among lipids and inflammation within persons infected with HIV need to be considered.

Letter to the Editor: Low-density lipoprotein is a potential predictor of poor prognosis in patients with coronavirus disease 2019

“…Although liver functions only exhibit mild abnormalities in protein synthesis ( Supplementary Table 1), whether lipid biogenesis has been impaired is yet to be determined. Second, viral infection induced proinflammatory cytokines modulate lipid metabolism including oxidation of LDL by reactive oxygen species singling to facilitate LDL clearance [11][12][13]. A measurement of oxidized LDL in patient's serum will aid in determining this mechanism.…”

Lipid Abnormalities in Persons Living With HIV Infection

“…30 Thus, monocyte and HDL-C dysfunction probably contribute to reduced reverse cholesterol transport in HIV infection, likely driven by chronic immune activation. 4 Circulating markers of monocyte activation (sCD14) predict mortality in HIV 31 and sCD163, a marker of macrophage activation, is associated with plaque in coronary lesions in HIV patients. 32 Compared with uninfected controls, participants infected with HIV in one study had heightened inflammation assessed using 18fluorine-2-deoxy-D-glucose positron emission tomography (FDG-PET), which was associated with a circulating marker of monocyte and macrophage activation.…”

“…Lipids interact with inflammatory markers, and inflammatory markers induce changes in lipoproteins to make them more atherogenic. 4 Heightened inflammation, highly atherogenic lipoproteins, and residual HIV infection contribute to a specific type of atherosclerosis in HIV, characterized by a higher prevalence of rupture-prone coronary plaques compared with "ordinary" atherosclerosis. 5 The primary goals of this review are: (1) to describe the lipid abnormalities associated with HIV; (2) to summarize how lipoproteins might be influenced by HIV-associated inflammation; (3) to discuss treatment of lipid abnormalities in individuals with HIV; and (4) to summarize important features of other CV risk factors in people living with HIV.…”

Disparities in the Quality of Cardiovascular Care Between HIV‐Infected Versus HIV‐Uninfected Adults in the United States: A Cross‐Sectional Study

“…Moreover, these increased risks persist even after adjusting for traditional risk factors such as smoking, which tend to be more prevalent among patients with HIV . Some antiretroviral medications also induce metabolic changes that interact with cardiovascular risk . Efforts to tailor cardiovascular risk prediction models for patients with HIV are under way .…”

“…medications also induce metabolic changes that interact with cardiovascular risk. 7 Efforts to tailor cardiovascular risk prediction models for patients with HIV are under way. 8 However, we know little about physicians' provision of cardiovascular care to patients with HIV, or how their cardiovascular care patterns compare with those of HIVuninfected patients.…”