Lipid Abnormalities and Inflammation in HIV Inflection

Abstract

Infection with the human immunodeficiency virus (HIV), and subsequent treatment with antiretroviral therapy (ART), is often associated with perturbations in lipid profiles. Furthermore, persistent inflammation, in spite of suppression of viral replication by ART, likely contributes to modifications in lipid composition and function, exacerbating risk for development of cardiovascular disease (CVD). Increased levels of several pro-inflammatory lipid species, including oxidized low-density lipoprotein (LDL) and high-density lipoprotein (HDL), have been measured in HIV-infected persons and are associated with markers of immune activation. The mechanisms linked to this bidirectional relationship in which inflammation increases lipid levels and promotes their modification, and these modified lipid species perpetuate inflammatory processes, require further investigation. Treatment with statins and other lifestyle modifications, including improvement in dietary intake and exercise, are critical to reducing CVD risk. Well-designed clinical trials that take into account the complex relationships among lipids and inflammation within persons infected with HIV need to be considered.

Keywords: Antiretroviral therapy; HDL cholesterol efflux; Inflammation; Lipid composition; Oxidized LDL; Statins.

Figure 1. Infection with HIV, and subsequent treatment with ART, is often associated with perturbations in lipid levels

Alterations in lipid profiles among HIV+ persons are complicated further by the bidirectional relationships among lipid metabolism and transport and persistent inflammation and immune activation. The effects of lipid lowering agents, including statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors), on lipid profiles and levels of chronic inflammation are currently being explored in persons living with HIV. {AU Query: Please add source of Figure 1 if not original.}