Emory Researchers Identify Link Between Lipid Abnormalities and AIDS
BOSTON-Researchers from Emory University and the Atlanta Veterans Affairs
Medical Center have used a lipid biomarker called apolipoprotein C-III
(ApoC-III) to help establish the relationship between HIV antiretroviral
therapy and the development of lipid abnormalities. The research was
presented on February 13th at the 10th Conference on Retroviruses and
Opportunistic Infections, held in Boston.
Antiretroviral therapy with
HIV protease inhibitors (PIs) and non-nucleoside reverse transcriptase
inhibitors (NNRTIs) has considerably reduced mortality from AIDS. However,
lipid abnormalities that may lead to premature atherosclerosis have
also become common among patients treated with antiretroviral therapy,
and scientists have been seeking the specific mechanisms involved in
this relationship. ApoC-III is a newly identified biomarker of lipid
metabolism that is believed to be a risk factor for coronary artery
disease because it produces elevated levels of triglycerides.
A research team led by Dr.
Virgil Brown from the Emory Lipid Research Laboratory and the VA Medical
Center working closely with Emory Center for AIDS Research (CFAR) investigators,
conducted two research studies -- one in a group of 202 HIV-positive
women and one in a group of 271 HIV-positive men at two HIV clinics:
the Atlanta VA and the Grady Infectious Diseases Program.
In the study of women, two-thirds
had received antiretroviral therapy (ARV) for at least three months,
25% had no therapy in the last three months, and 9% had received no
ARV therapy. In the study of men, 85% had received ARV for more than
three months and 15% had received no ARV therapy.
In both groups, patients
treated with either PIs or NNRTIs were more likely to have higher ApoC-III
levels than patients on no therapy, and the elevated level of this biomarker
corresponded to elevated triglyceride levels in both treatment groups.
"This new ApoC-III biomarker
has allowed us to establish a relationship between lipid metabolism
and antiretroviral therapy," said Carlos del Rio, MD, associate professor
of medicine at Emory University School of Medicine. "This suggests that
patients undergoing HIV therapy have impaired metabolism of triclyceride-rich
lipoproteins. Because a large number of these patients also smoke and/or
have diabetes, they are at increased risk of atherosclerosis, heart
attack, and stroke."
The research team consisted
of Isabel Hernandez, MD and Erik Folch, MD, postdoctoral fellows in
the Emory AIDS International Training and Research Program; Ngoc Anh
Le, PhD and Virgil Brown, MD from the Emory Lipid Research Laboratory
at the VA Medical Center; Carlos del Rio, MD and Jeffrey Lennox, MD
from the Grady Infectious Diseases Program and David Rimland MD Chief
of Infectious Diseases at the Atlanta VA Medical Center. The study was
funded by the National Institutes of Health.