Highly Active Antiretroviral Therapy Does Not Significantly Raise Cholesterol Levels, Study Says

Treatment with highly active antiretroviral therapy does not appear to raise cholesterol levels in HIV-positive men, according to a study published in today's issue of the Journal of the American Medical Association. The study, conducted by researchers at the University of Pittsburgh, helps to clarify widespread reports that patients who take HAART experience increases in their blood lipid levels. The researchers used data on 50 men who have sex with men who participated in the ongoing NIH-funded Multicenter AIDS Cohort Study, which has enrolled 5,622 men, both HIV-positive and HIV-negative, in Pittsburgh, Baltimore, Chicago and Los Angeles. The researchers analyzed the lipid levels of the men before they contracted HIV; after infection but before the initiation of HAART; at two points during HAART between 1997 and 1999; and at two points during HAART between 2000 and 2002.

Results
The researchers found that before HIV infection the participants had an average total cholesterol of 201 mg/dL, an average low-density lipoprotein level of 122 mg/dL and an average high-density lipoprotein level of 51 mg/dL, all of which are in the normal range of the general population of adult men (University of Pittsburgh release, 6/10). According to the NIH's National Heart, Lung and Blood Institute, LDL, or "bad cholesterol," should be below 100 mg/dL, total cholesterol should be below 200 mg/dL and HDL, or "good cholesterol," should be as high as possible (National Cholesterol Education Program Web site, 6/10). After HIV infection but prior to the initiation of HAART, participants' average total cholesterol level dropped 30 mg/dL, 22 mg/dL for LDL and 12 mg/dL for HDL. After the initiation of HAART, total and LDL cholesterol levels began to rise, and after three years of treatment the levels reached an average of 221 mg/dL total cholesterol and 121 mg/dL LDL, reaching levels close to pre-HIV-infection levels. However, participants' average HDL levels dropped 9 mg/dL to 42 mg/dL.

Implications
"The results confirmed that yes, total cholesterol does increase with HAART, but in most cases it increases back to or near the pre-infection level, and in that sense it represents a return to normal," study author Sharon Riddler, assistant professor of medicine at the University of Pittsburgh Medical School, said, adding, "The mean increase in total cholesterol of 20 milligrams noted in the study is consistent with a similar total cholesterol level increase in healthy men as they age and would be considered a normal increase for the study participants over the 12-year span of our analysis" (University of Pittsburgh release, 6/10). The study authors state that further research is necessary to determine if a longer duration of HAART treatment leads to further increases in cholesterol levels. In addition, they note that the size of the study allows for "only moderately precise" estimates in cholesterol level changes. Finally, the authors state that further studies involving women and minorities are needed to determine whether such findings could be generalized to a wider population (Riddler et al., JAMA, 6/11). Riddler also expressed concern that by the end of the study, the participants' average triglyceride levels were higher (225 mg/dL) than average for similar-aged men in the general population and HDL levels were lower (42 mg/dL) than average. "The fact that average triglyceride and HDL levels were at unhealthy levels at the completion of this study raises a red flag in terms of heart disease risk," Riddler said (University of Pittsburgh release, 6/10).