Cardiovascular disease risk factors in HIV patients – association with antiretroviral therapy. Results from the DAD study

Abstract

HIV-infected persons exhibit multiple known risk factors for CVD. Of specific concern is the fact that use of the NNRTI and PI drug classes (alone and especially in combination), particularly among older subjects with normalized CD4 cell counts and suppressed HIV replication, was associated with a lipid profile known to increase the risk of coronary heart disease.

Association of non-HDL cholesterol with subclinical atherosclerosis in HIV-positive patients

“…<0.01 ) or non significant. 6. We agree that the presence of lipo-accumulation influences the waist perimeter and so we 6 .…”

“…6. We agree that the presence of lipo-accumulation influences the waist perimeter and so we 6 . Surprisingly, there are contradictory reports on the association between low density lipoprotein cholesterol (LDL-C), the most recognized lipid risk factor in non-HIV populations 7 , and CIMT in HIV+ populations [8][9][10][11] .…”

“…Although an increase in non-HDL-C was statistically associated to increased CIMT in univariate analysis only (See Table 1), it appears necessary to reach the non-HDL-C goal after the LDL-C goal in HIV+ patients who are generally exposed to multiple CV risks and predisposed to increased atherosclerosis 6,[8][9][10]12 . A particularity of dyslipidemia in HIV+ patients treated by c-ART is the combination of lipid disturbances related firstly to the HIV infection per se and secondly induced by c-ART.…”

“…However emergence of cardiovascular (CV) complications related to HIV infection per se and/or to c-ART has raised clinical and public health concerns [2][3][4][5] given the increasing duration of exposure to c-ART. Several classical CV risk factors including age, gender, body mass index (BMI), blood pressure, increased total cholesterol (TC) levels or tobacco consumption have been previously recognized in HIV+ patients 6 . Surprisingly, there are contradictory reports on the association between low density lipoprotein cholesterol (LDL-C), the most recognized lipid risk factor in non-HIV populations 7 , and CIMT in HIV+ populations [8][9][10][11] .…”

“…So, we removed them from the criteria in the text and added the following sentence: "In addition, patients treated by hypertensive medications were categorized as having high blood pressure, and patients receiving fibrate treatment were considered as having TG>1.5 g/l". (page 6) In this study, 7 patients were defined as having a MS on the basis of an hypertensive/or fibrate treatment.…”