Coronary artery calcification, atherogenic lipid changes, and increased erythrocyte volume in black injection drug users infected with human immunodeficiency virus-1 treated with protease inhibitors

Abstract

Background Protease inhibitors (PIs) may be associated with accelerated atherosclerosis in individuals infected with human immunodeficiency virus (HIV). We assessed the effects of HIV PIs on subclinical atherosclerosis. Methods The lipid profiles, C-reactive protein (CRP) levels, coronary artery calcification (CAC) scores, and blood cell morphologic changes were quantified in 98 black adult participants, aged 25 to 45 years, with HIV-1 infection in Baltimore, Md. Fifty-five participants (56.1%) were taking PIs; 43 participants (43.9%) were not. The Student t and χ2 tests were used as a means of detecting the between-group differences. Results Participants in both the PI and non-PI groups were similar in age, sex, body mass index, blood pressure, heart rate, and red and white blood cell counts. Compared with the non-PI group, the PI group had significantly higher serum total cholesterol (4.8 ± 1.0 vs 3.8 ± 0.7 mmol/L, P <.001) and LDL cholesterol (2.9 ± 0.8 vs 2.1 ± 0.7 mmol/L, P <.001) levels and red blood cell mean corpuscular volume (92.2 ± 9.3 vs 86.8 ± 7.2 μm3, P =.048). The CAC scores in the PI group were also higher than those in the non-PI group (11.0 ± 28.6 [n = 43] vs 1.7 ± 5.8, P =.043). CAC scores were marginally associated with log-transformed duration of the PI therapy (P =.055). Serum CRP levels remained unchanged (5.5 ± 13.6 mg/L [n = 45] vs 3.9 ± 5.5 mg/L, P =.467). Serum total cholesterol level, LDL cholesterol level, red blood cell mean corpuscular volume, and CAC scores were indicated by means of regression analyses to be associated with log-transformed duration of the PI therapy. Conclusions The use of PIs is associated with coronary artery calcification, atherogenic lipid changes, and increased erythrocyte volume in individuals infected with HIV-1. (Am Heart J 2002;144:642-8.)