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Lipid Abnormalities in a Never-Treated HIV-1 Subtype C-Infected African Population

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Lipids

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Abstract

Dyslipidemia has been documented worldwide among human immunodeficiency virus-infected (HIV) individuals and these changes are reminiscent of the metabolic syndrome (MetS). In South Africa, with the highest number of HIV infections worldwide, HIV-1 subtype C is prevalent, while HIV-1 subtype B (genetically different from C) prevails in Europe and the United States. We aimed to evaluate if HIV infection (subtype C) is associated with dyslipidemia, inflammation and the occurrence of the MetS in Africans. Three hundred newly diagnosed HIV-infected participants were compared to 300 age, gender, body mass index and locality matched uninfected controls. MetS was defined according to the Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) criteria. The HIV-infected group showed lower high density lipoprotein cholesterol (1.23 vs. 1.70 mmol/L) and low density lipoprotein cholesterol (2.60 vs. 2.80 mmol/L) and higher triglycerides (1.29 vs. 1.15 mmol/L), C-reactive protein (3.31 vs. 2.13 mg/L) and interleukin 6 (4.70 vs. 3.72 pg/L) levels compared to the uninfected group. No difference in the prevalence of the MetS was seen between the two groups (ATP III, 15.2 vs. 11.5%; IDF, 21.1 vs. 22.6%). This study shows that HIV-1 subtype C is associated with dyslipidemia, but not with a higher incidence of MetS in never antiretroviral-treated HIV-infected Africans.

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Abbreviations

AIDS:

Acquired immunodeficiency syndrome

ARV:

Antiretroviral

ATP III:

Adult Treatment Panel III

BMI:

Body mass index

CI:

Confidence intervals

CVD:

Cardiovascular disease

DBP:

Diastolic blood pressure

FG:

Fasting glucose

HDL-C:

High-density lipoprotein cholesterol

HIV:

Human immunodeficiency virus

HR:

Heart rate

hs-CRP:

High sensitivity C-reactive protein

hs-IL-6:

High sensitivity interleukin-6

IDF:

International Diabetes Federation

LDL-C:

Low-density lipoprotein cholesterol

MetS:

Metabolic syndrome

OR:

Odds ratios

PP:

Pulse pressure

PURE:

Prospective urban and rural epidemiological

SBP:

Systolic blood pressure

TC:

Total cholesterol

TG:

Triglycerides

WC:

Waist circumference

References

  1. UNAIDS (2008) Sub-Saharan Africa. Aids epidemic update. Regional Summary. http://data.unaids.org/pub/Report/2008/jc1526_epibriefs_ssafrica_en.pdf. Accessed March 2009

  2. Peeters M (2001) The genetic variability of HIV-1 and its implications. Transfus Clin Biol 8:222–225

    Article  CAS  PubMed  Google Scholar 

  3. Jacobs GB, de Beer C, Fincham JE, Adams V, Dhansay MA, van Rensburg EJ, Engelbrecht S (2006) Serotyping and genotyping of HIV-1 infection in residents of Khayelitsha, Cape Town, South Africa. J Med Virol 78:1529–1536

    Article  CAS  PubMed  Google Scholar 

  4. Thomson MM, Najera R (2005) Molecular epidemiology of HIV-1 variants in the global AIDS pandemic: an update. AIDS Rev 7:210–224

    PubMed  Google Scholar 

  5. Freire E (2006) Overcoming HIV-1 resistance to protease inhibitors. Drug Discov Today 3(2):281–286

    Article  Google Scholar 

  6. Gaschen B, Taylor J, Yusim K, Foley B, Gao F, Lang D, Novitsky V, Haynes B, Hahn BH, Bhattacharya T, Korber B (2002) Diversity considerations in HIV-1 vaccine selection. Science 296:2354–2360

    Article  CAS  PubMed  Google Scholar 

  7. Simon V, Ho DD, Abdool KQ (2006) HIV/AIDS epidemiology, pathogenesis, prevention, and treatment. Lancet 368:489–504

    Article  PubMed  Google Scholar 

  8. Riddler SA, Smit E, Cole SR, Li R, Chmiel JS, Dobs A, Palella F, Visscher B, Evans R, Kingsley LA (2003) Impact of HIV infection and HAART on serum lipids in men. JAMA 289:2978–2982

    Article  CAS  PubMed  Google Scholar 

  9. Carr A, Cooper DA (1998) Images in clinical medicine Lipodystrophy associated with an HIV-protease inhibitor. N Engl J Med 339:1296

    Article  CAS  PubMed  Google Scholar 

  10. Grinspoon SK (2005) Metabolic syndrome and cardiovascular disease in patients with human immunodeficiency virus. Am J Med 118(Suppl 2):23S–28S

    PubMed  Google Scholar 

  11. Constans J, Conri C (2006) Circulating markers of endothelial function in cardiovascular disease. Clin Chim Acta 368:33–47

    Article  CAS  PubMed  Google Scholar 

  12. Hsue PY, Lo JC, Franklin A, Bolger AF, Martin JN, Deeks SG, Waters DD (2004) Progression of atherosclerosis as assessed by carotid intima-media thickness in patients with HIV infection. Circulation 109:1603–1608

    Article  PubMed  Google Scholar 

  13. Glazier JJ, Spears JR, Murphy MC (2006) Interventional approach to recurrent myocardial infarction in HIV-1 infection. J Interv Cardiol 19:93–98

    Article  PubMed  Google Scholar 

  14. Sudano I, Spieker LE, Noll G, Corti R, Weber R, Luscher TF (2006) Cardiovascular disease in HIV infection. Am Heart J 151:1147–1155

    Article  PubMed  Google Scholar 

  15. Rose H, Woolley I, Hoy J, Dart A, Bryant B, Mijch A, Sviridov D (2006) HIV infection and high-density lipoprotein: the effect of the disease vs the effect of treatment. Metabolism 55:90–95

    Article  CAS  PubMed  Google Scholar 

  16. Asztalos BF, Schaefer EJ, Horvath KV, Cox CE, Skinner S, Gerrior J, Gorbach SL, Wanke C (2006) Protease inhibitor-based HAART, HDL, and CHD-risk in HIV-infected patients. Atherosclerosis 184:72–77

    Article  CAS  PubMed  Google Scholar 

  17. Tershakovec AM, Frank I, Rader D (2004) HIV-related lipodystrophy and related factors. Atherosclerosis 174:1–10

    Article  CAS  PubMed  Google Scholar 

  18. Fisher SD, Miller TL, Lipshultz SE (2006) Impact of HIV and highly active antiretroviral therapy on leukocyte adhesion molecules, arterial inflammation, dyslipidemia, and atherosclerosis. Atherosclerosis 185:1–11

    Article  CAS  PubMed  Google Scholar 

  19. de Gaetano DK, Rabagliati R, Iacoviello L, Cauda R (2004) HIV infection, HAART, and endothelial adhesion molecules: current perspectives. Lancet Infect Dis 4:213–222

    Article  Google Scholar 

  20. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (2002) Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 106(25):3143–3421

    Google Scholar 

  21. Martin LS, Pasquier E, Roudaut N, Vandhuick O, Vallet S, Bellein V, Bressollette L (2008) Metabolic syndrome: a major risk factor for atherosclerosis in HIV-infected patients (SHIVA study). Presse Med 37:579–584

    Article  Google Scholar 

  22. Salyer J, Lyon DE, Settle J, Elswick RK, Rackley D (2006) Coronary heart disease risks and lifestyle behaviors in persons with HIV infection. J Assoc Nurses AIDS Care 17:3–17

    Article  PubMed  Google Scholar 

  23. Bonfanti P, Giannattasio C, Ricci E, Facchetti R, Rosella E, Franzetti M, Cordier L, Pusterla L, Bombelli M, Sega R, Quirino T, Mancia G (2007) HIV and metabolic syndrome: a comparison with the general population. J Acquir Immune Defic Syndr 45:426–431

    Article  PubMed  Google Scholar 

  24. World Medical Association Declaration of Helsinki (accessed February. 2009) Ethical principals for Medical Research Involving Human Subjects. http://www.wma.net/e/policy/b3.htm

  25. Jones M (2001) International Society for the Advancement of Kinanthropometry (ISAK). International standards for anthropometric assessment, Adelaide, National Library of Australia

  26. Johnson R, McNutt P, MacMahon S, Robson R (1997) Use of the Friedewald formula to estimate LDL-cholesterol in patients with chronic renal failure on dialysis. Clin Chem 43:2183–2184

    CAS  PubMed  Google Scholar 

  27. Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16(1):31–41

    Article  CAS  PubMed  Google Scholar 

  28. International Diabetes Federation (2009) The IDF consensus worldwide definition of the metabolic syndrome. http://www.idf.org/webdata/docs/Metabolic_syndrome_definition.pdf. Accessed March 2009

  29. Rose H, Hoy J, Woolley I, Tchoua U, Bukrinsky M, Dart A, Sviridov D (2007) HIV infection and high density lipoprotein metabolism. Atherosclerosis 199(1):79–86

    Article  PubMed  CAS  Google Scholar 

  30. Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR (1977) High density lipoprotein as a protective factor against coronary heart disease. The Framingham Study. Am J Med 62:707–714

    Article  CAS  PubMed  Google Scholar 

  31. Castelli WP, Anderson K, Wilson PW, Levy D (1992) Lipids and risk of coronary heart disease. The Framingham Study. Ann Epidemiol 2:23–28

    Article  CAS  PubMed  Google Scholar 

  32. Duprez DA, Kuller LH, Tracy R, Otvas J, Cooper DA, Hoy J, Neuhaus J, Paton NI, Friis-Moller N, Lampe F, Liappis AP, Neaton JD (2009) Lipoprotein particle subclasses, cardiovascular disease and HIV infection. Doi:10.1016/j.atherosclerosis.2009.05.001

  33. Jericó C, Knobel H, Sorli ML, Montero M, Guelar A, Pedro-Botet J (2006) Prevalence of cardiovascular risk factors in HIV-infected patients. Rev Clin Esp 206(11):556–559

    Article  PubMed  Google Scholar 

  34. Seedat YK (1999) Hypertension in black South Africans. J Hum Hypertens 13:96–103

    CAS  PubMed  Google Scholar 

  35. Miller NE, Thelle DS, Forde OH, Mjos OD (1977) The Tromso heart-study. High-density lipoprotein and coronary heart-disease: a prospective case-control study. Lancet 1:965–968

    CAS  Google Scholar 

  36. Badiou S, Thiebaut R, urillac-Lavignolle V, Dabis F, Laporte F, Cristol JP, Mercie P (2008) Association of non-HDL cholesterol with subclinical atherosclerosis in HIV-positive patients. J Infect 57:47–54

    Article  CAS  PubMed  Google Scholar 

  37. Samaras K, Wand H, Law M, Emery S, Cooper D, Carr A (2007) Prevalence of metabolic syndrome in HIV-infected patients receiving highly active antiretroviral therapy using International Diabetes Foundation and Adult Treatment Panel III criteria: associations with insulin resistance, disturbed body fat compartmentalization, elevated C-reactive protein, and [corrected] hypoadiponectinemia. Diabetes Care 30:113-119

    Google Scholar 

  38. Carpentier A, Patterson BW, Uffelman KD, Salit I, Lewis GF (2005) Mechanism of highly active anti-retroviral therapy-induced hyperlipidemia in HIV-infected individuals. Atherosclerosis 178:165–172

    Article  CAS  PubMed  Google Scholar 

  39. Krauss RM (2004) Lipids and lipoproteins in patients with type 2 diabetes. Diabetes Care 27:1496–1504

    Article  CAS  PubMed  Google Scholar 

  40. Bonfanti P, Ricci E, de Socio G, Zeme D, Carradori S, Penco G, Parruti G, Grosso C, Madeddu G, Vichi F, Bini T, Martinelli C, Melzi S, Quirino T (2006) Metabolic syndrome: a real threat for HIV-positive patients? Results from the SIMONE study. J Acquir Immune Defic Syndr 42:128–131

    Article  PubMed  Google Scholar 

  41. Mondy K, Overton ET, Grubb J, Tong S, Seyfried W, Powderly W, Yarasheski K (2007) Metabolic syndrome in HIV-infected patients from an urban, Midwestern US outpatient population. Clin Infect Dis 44:726–734

    Article  PubMed  Google Scholar 

  42. Pao V, Lee GA, Grunfeld C (2008) HIV therapy, metabolic syndrome, and cardiovascular risk. Curr Atheroscler Rep 10:61–70

    Article  CAS  PubMed  Google Scholar 

  43. Puoane T, Steyn K, Bradshaw D, Laubscher R, Fourie J, Lambert V, Mbananga N (2002) Obesity in South Africa: the South African demographic and health survey. Obes Res 10:1038–1048

    Article  PubMed  Google Scholar 

  44. Schutte AE, Schutte R, Huisman HW, Rooyen JM, Malan L, Olckers A, Malan NT (2009) Classifying Africans with the metabolic syndrome. Horm Metab Res 41:79–85

    Article  CAS  PubMed  Google Scholar 

  45. Grinspoon S, Carr A (2005) Cardiovascular risk and body-fat abnormalities in HIV-infected adults. N Engl J Med 352:48–62

    Article  CAS  PubMed  Google Scholar 

  46. Lichtenstein KA, Ward DJ, Moorman AC, Delaney KM, Young B, Palella FJ Jr, Rhodes PH, Wood KC, Holmberg SD (2001) Clinical assessment of HIV-associated lipodystrophy in an ambulatory population. AIDS 15:1389–1398

    Article  CAS  PubMed  Google Scholar 

  47. Abbasi F, Brown BW Jr, Lamendola C, McLaughlin T, Reaven GM (2002) Relationship between obesity, insulin resistance, and coronary heart disease risk. J Am Coll Cardiol 40:937–943

    Article  CAS  PubMed  Google Scholar 

  48. Ridker PM, Buring JE, Cook NR, Rifai N (2003) C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14 719 initially healthy American women. Circulation 107:391–397

    Article  PubMed  Google Scholar 

  49. Pasceri V, Willerson JT, Yeh ET (2000) Direct proinflammatory effect of C-reactive protein on human endothelial cells. Circulation 102:2165–2168

    CAS  PubMed  Google Scholar 

  50. Wadham C, Albanese N, Roberts J, Wang L, Bagley CJ, Gamble JR, Rye KA, Barter PJ, Vadas MA, Xia P (2004) High-density lipoproteins neutralize C-reactive protein proinflammatory activity. Circulation 109:2116–2122

    Article  CAS  PubMed  Google Scholar 

  51. Opie LH, Seedat YK (2005) Hypertension in sub-Saharan African populations. Circulation 112:3562–3568

    Article  PubMed  Google Scholar 

  52. van Rooyen JM, Kruger HS, Huisman HW, Wissing MP, Margetts BM, Venter CS, Vorster HH (2000) An epidemiological study of hypertension and its determinants in a population in transition: the THUSA study. J Hum Hypertens 14:779–787

    Article  PubMed  Google Scholar 

  53. Jericó C, Knobel H, Montero M, Sorli ML, Guelar A, Gimeno JL, Saballs P, Lopez-Colomes JL, Pedro-Botet J (2005) Hypertension in HIV-infected patients: prevalence and related factors. Am J Hypertens 18:1396–1401

    Article  PubMed  Google Scholar 

  54. Gazzaruso C, Bruno R, Garzaniti A, Giordanetti S, Frantino P, Sacchi P, Filice G (2003) Hypertension among HIV patients: prevalence and relationships to insulin resistance and metabolic syndrome. J Hypertens 21(7):1377–1382

    Article  CAS  PubMed  Google Scholar 

  55. Winston J, Deray G, Hawkins T, Szczech L, Wyatt C, Young B (2008) Kidney disease in patients with HIV infection and AIDS. Clin Infect Dis 47:1449–1457

    Article  PubMed  Google Scholar 

  56. Holzemer WL, Uys LR (2004) Managing AIDS stigma. SAHARA J 1:165–174

    CAS  PubMed  Google Scholar 

  57. Greeff M, Phetlhu R (2007) The meaning and effect of HIV/AIDS stigma for people living with AIDS and nurses involved in their care in the North West Province, South Africa. Curationis 30:12–23

    CAS  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank the PURE-SA research team, especially Dr. M Watson, who was responsible for the HIV testing and counseling, the field workers and office staff in the Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, South Africa. PURE International, Dr. S Yusuf and the PURE project staff at the PHRI, Hamilton Health Sciences and McMaster University, ON, Canada. This work was financially supported by SANPAD (South Africa—Netherlands Research Program on Alternatives in Development), South African National Research Foundation (NRF GUN numbers 2069139 and FA2006040700010), North-West University, Population Health Research Institute (PHRI), and the Medical Research Council (MRC) of South Africa.

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Authors and Affiliations

  1. HART (Hypertension in Africa Research Team), Subject Group Physiology, North-West University, Potchefstroom, South Africa

    Carla Maria T. Fourie, Johannes M. Van Rooyen & Aletta E. Schutte

  2. AUTHeR (Africa Unit for Transdisciplinary Health Research), Faculty of Health Science, North-West University, Potchefstroom, South Africa

    Annamarie Kruger

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  1. Carla Maria T. Fourie
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  2. Johannes M. Van Rooyen
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  3. Annamarie Kruger
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  4. Aletta E. Schutte
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Correspondence to Carla Maria T. Fourie.

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Fourie, C.M.T., Van Rooyen, J.M., Kruger, A. et al. Lipid Abnormalities in a Never-Treated HIV-1 Subtype C-Infected African Population. Lipids 45, 73–80 (2010). https://doi.org/10.1007/s11745-009-3369-4

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  • DOI: https://doi.org/10.1007/s11745-009-3369-4

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