Immunosuppression and HIV Viremia Associated with More Atherogenic Lipid Profile in Older People with HIV

Abstract

To explore reasons for the disproportionate metabolic and cardiovascular disease burdens among older HIV-infected persons, we investigated whether associations of CD4 count and HIV viral load (VL) with non-high-density lipoprotein cholesterol (non-HDL-C) and high-density lipoprotein cholesterol [HDL-C] differed by age. Longitudinal clinical and laboratory data were collected between 2011 and 2016 for HIV-infected outpatients in the DC Cohort study. Using data for patients aged ≥21 years with ≥1 cholesterol result and contemporaneous CD4/VL results, we created multivariable linear regression models with generalized estimating equations. Among 3,912 patients, the median age was 50 years, 78% were male, 76% were non-Hispanic black, 93% were using antiretroviral therapy, 8% had a CD4 count <200 cells/μL, and 18% had an HIV VL ≥200 copies/mL. Overall, CD4 count <200 (vs. >500) cells/μL and VL ≥200 copies/mL were associated with lower non-HDL-C concentrations (p < .01), but associations were more positive with increasing age (CD4-age/VL-age interactions, p < .01). CD4 count <200 cells/μL was associated with lower non-HDL-C among patients aged <50 years [β = -7.8 mg/dL (95% confidence interval, CI: -13.2 to -2.4)] but higher non-HDL-C among patients aged 60-69 years [β = +8.1 mg/dL (95% CI: 0.02-16.2)]. VL ≥200 copies/mL was associated with lower non-HDL-C among patients aged <50 years [β = -3.3 mg/dL (95% CI: -6.7 to 0.1)] but higher non-HDL-C among patients aged ≥70 years [β = +16.0 mg/dL (95% CI: -1.4 to 33.3)], although precision was reduced in age-stratified analyses. Although no age differences were detected for HDL-C, VL ≥200 copies/mL was more strongly associated with lower HDL-C concentrations when CD4 count was <200 cells/μL [β = -7.0 mg/dL (95% CI: -9.7 to -4.3)] versus 200-500 cells/μL [β = -4.2 (95% CI: -5.9 to -2.6)] or >500 cells/μL [β = -2.2 (95% CI: -3.7 to -0.8)] (CD4-VL interaction, p < .01). We detected a novel age-modified relationship between immunosuppression and viremia and atherogenic cholesterol patterns. These findings may contribute to our understanding of the high risk of dyslipidemia observed among persons aging with HIV.

Keywords: CD4 cell count; HIV; age; cholesterol; viral load.

FIG. 1.

Associations of CD4 cell count and HIV viral load with non-HDL-C concentration by age group. Using multivariable linear regression with generalized estimating equations, all results were adjusted for CD4 cell count, HIV viral load, sex, race/ethnicity, HIV transmission group, history of smoking, depression, anxiety/stress disorder, hypertension, diabetes, body mass index category, hepatitis C infection, chronic kidney disease, serum albumin, length of time since HIV diagnosis, history of AIDS diagnosis, current antiretroviral regimen class, and the current use of a lipid-lowering agent. HDL-C, high-density lipoprotein cholesterol.

FIG. 2.

Association between HIV viral load and HDL-C concentration by CD4 cell count. Using multivariable linear regression with generalized estimating equations, all results were adjusted for age, sex, race/ethnicity, HIV transmission group, history of smoking, depression, anxiety/stress disorder, hypertension, diabetes, body mass index category, hepatitis C infection, chronic kidney disease, serum albumin, length of time since HIV diagnosis, history of AIDS diagnosis, current antiretroviral regimen class, and the current use of a lipid-lowering agent.