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Riddler SA, Smit E, Cole SR, et al. Impact of HIV Infection and HAART on Serum Lipids in Men. JAMA. 2003;289(22):2978–2982. doi:10.1001/jama.289.22.2978
Author Affiliations: University of Pittsburgh, Pittsburgh, Pa (Drs Riddler, Evans, and Kingsley); State University of New York at Buffalo (Dr Smit); Johns Hopkins University, Baltimore, Md (Drs Cole and Dobs, and Ms Li); Northwestern University, Chicago, Ill (Drs Chmiel and Palella); and University of California, Los Angeles (Dr Visscher).
Context Alterations in serum lipid values have been widely reported among persons
infected with human immunodeficiency virus (HIV) type 1 treated with highly
active antiretroviral therapy (HAART), but no data have yet been reported
on changes from preseroconversion lipid values.
Objective To describe changes in serum cholesterol levels associated with HIV
infection and antiretroviral medication exposure, and 1-time assessment of
triglyceride levels post-HAART initiation.
Design, Setting, and Participants The Multicenter AIDS Cohort Study, a prospective study in which homosexual
and bisexual men were enrolled and from which 50 of 517 HIV seroconverters
were drawn for the analysis herein, who later initiated HAART, involving measurements
of stored serum samples obtained between 1984 and 2002.
Main Outcome Measures Changes in levels of total cholesterol (TC), high-density lipoprotein
cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) at 6
time points during an average of 12 years; 1-time assessment of triglyceride
levels from the third post-HAART clinic visit.
Results Among the 50 men, notable declines in mean serum TC (–30 mg/dL
[−0.78 mmol/L]), HDL-C (–12 mg/dL [−0.31 mmol/L]), and LDL-C
values (–22 mg/dL [−0.57 mmol/L]) were observed after HIV infection.
Following HAART initiation, there were large increases in mean TC and LDL-C
values (50 and 21 mg/dL [1.30 and 0.54 mmol/L], respectively); however, the
mean changes from the preseroconversion values were 20 mg/dL (0.52 mmol/L)
(95% confidence interval [CI], –1 to 41) and –1 mg/dL (−0.03
mmol/L) (95% CI, –25 to 22), respectively. Mean HDL-C remained below
baseline levels throughout follow-up. The median value (interquartile range)
of triglycerides was 225 mg/dL (2.54 mmol/L) (147-331 mg/dL).
Conclusions Before treatment, HIV infection results in substantial decreases in
serum TC, HDL-C, and LDL-C levels. Subsequent HAART initiation is associated
with increases in TC and LDL-C but little change in HDL-C. Increases in TC
and LDL-C observed after about 3 years of HAART possibly represent a return
to preinfection serum lipid levels after accounting for expected age-related
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