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HIV Antiretroviral-Related Hyperlipidemia is Mitigated by HCV Co-Infection
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Reported by Jules Levin
At ICAAC, Cooper from Ottawa Hospital in Ottawa, Canada reported that lipids remain under control on HAART in HCV/HIV coinfected individuals but after interferon therapy lipids increase. That was my personal experience and I have been saying this for several years. After I completed peginterferon plus ribavirin therapy my lipids increased out of control on the same HAART regimen. I think that theHCV-infected liver is unable to synthesize lipids normally, but after successful interferon therapy for HCV the liver is regains the ability to synthesize lipids normally.
ABSTRACT
Hyperlipidemia is a recognized complication of HIV antiretroviral therapy. The interactions between HIV, HCV, antiretrovirals and lipids are not well-described.
Lipid data of patients receiving antiretroviral therapy at the Ottawa Hospital Immunodeficiency Clinic between January 1996 and June 2005 was evaluated using a clinic database. Analysis was by Student t-test and Chi square (SPSS 12.0).
729 HIV mono-infected and 305 HIV-HCV co-infected subjects attended at least one clinic. Of these, 561 (77%) and 217 (71%), initiated at least one round of HAART, respectively. In these subjects, the mean changes in cholesterol (mmol/L) from baseline to months 6 and 12 were 0.99 and 1.43 in HIV mono-infection, and 0.16 (p<0.001) and 0.01 (p<0.01) in HIV-HCV, respectively. This difference between HIV and HIV-HCV remained significant (p<0.05) at months 12, 18, 24 and 30 of HAART.
Metabolic complications including hypercholesterolemia resulted in interruption of HAART in HIV mono-infection (7%) but not in those with HIV-HCV (<1%) (p<0.001). Eight percent of HIV mono-infected and no co-infected subject initiated lipid lower therapy while on their initial course of HAART (p<0.001). For subsequent regimens, lipid therapy was initiated during therapy in 22% of HIV mono-infected patients and 4% in those with co-infection (p<0.001). Of note, there was more protease inhibitor use in co-infected subjects (p<0.01).
The authors found that after HCV therapy with interferon lipids worsen.
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