2nd International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 13-15 September 2000, Toronto, Canada

APOLIPOPROTEIN CIII AND HIGHLY ACTIVE ANTIRETROVIAL THERAPY-INDUCED HYPERTRIGLYCERIDEMIA

Antiviral Therapy 2000; 5(Suppl. 5):30 (abstract no. P11)

AM Dupuy, S Badiou, V Baillat, J Fabre, MD Tur, JP Cristol and J Reynes
University Hospital, Montpellier, France

BACKGROUND: Hypertriglyceridemia (HTG) has been frequently reported in HIV patients treated with HAART, and particularly with protease inhibitors (PI). Impairment of lipoprotein lipase activity by apolipoprotein CIII (apoCIII) could be involved in this HTG and could further enhance its atherogenicity by the occurrence of small dense LDL subfractions.

OBJECTIVES: To evaluate the relationship between apoCIII and HAART-induced hypertriglyceridemia.

DESIGN: Total cholesterol (TC), TG, apoB, apoCIII were determined in 188 HIV-positive adults (40.3±10 years) receiving at least one PI (n=142), or PI-naïve (n=46), and in 58 healthy HIV-negative controls (41±13 years). Five groups were defined: (I) indinavir (n=31), (II) nelfinavir (n=55), (III) saquinavir ±nelfinavir (n=24), (IV) ritonavir plus saquinavir (n=32) and (V) PI-naïve (n=46).

RESULTS: TG was significantly elevated in HIV antiviral treated patients when compared to controls (2.38±0.23 versus 1.02±0.05 mmol/l, P<0.001), while TC (5.49±0.12 versus 5.40±0.13 mmol/l) and Apo B (1.16±0.03 versus 1.02±0.03 g/l) were similar. The prevalence of HTG, defined as TG >2 mmol/l, was 33% in HIV groups compared to 1.7% in controls. Prevalence of HTG was significantly higher (53.5%) in group IV when compared to groups I, II, III and V (38.7, 25.5, 25 and 28.3%, respectively; P<0.03). Maximum values of TG (4.45±0.79 mmol/l) and apoCIII (250.5±44.3µg/l) were observed in group IV and were significantly increased when compared to other PI, including groups I, II and III (TG, 2.07±0.31; apoCIII, 188.4±11). A significant correlation between apoCIII and TG was found in group I to V (r=0.92, 0.58, 0.92, 0.93 and 0.80, respectively).

CONCLUSION: HAART-induced HTG could be, in part, linked to an increase in apoCIII levels. Since fibrates decrease apoCIII expression, they appear to be an effective option to manage HAART-induced HTG.

000913
P11

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