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HAART to Heart: Uncertain Consequences in HIV

Medically Reviewed On: June 13, 2003

By Christine Haran

There is no question that most people with HIV are living longer, healthier lives when they have good access to medical therapy. The best available treatments today, which include a combination of medications called highly active antiretroviral therapy (HAART), can often, if taken consistently and correctly, keep HIV under control. Many people have now been taking these therapies for years now and some long-term side effects have surfaced, including high cholesterol—a known risk factor for heart disease and stroke. While increases in cholesterol levels have been seen in people taking HAART, a new study has found that, for patients in the study, after three years of therapy, their average total cholesterol and LDL cholesterol, or the "bad cholesterol," was essentially the same as it was before HIV infection. The study was published in the June 2003 issue of the Journal of the American Medical Association.

Researchers analyzed the blood samples of 50 men that were taken before HIV infection, after infection but before they began HAART, and four times over the course of the therapy. The data were drawn from the Multicenter AIDS Cohort Study (MACS), which is a 19-year study involving HIV-positive and HIV-negative homosexual and bisexual men.

To the researchers' surprise, total and LDL cholesterol levels, which dropped after HIV infection, returned to normal with HAART. However, at the end of the study, triglyeride levels in the blood, another heart disease risk factor, were higher than those of HIV-negative men of the same age, and levels of HDL cholesterol, the "good cholesterol" were lower than those of uninfected men. As a result, increased risk of heart attack and stroke may still be a concern for those on HAART, albeit a lesser one than previously thought. Below, lead study author Sharon Riddler, MD, MPH, an associate professor of medicine at the University of Pittsburgh, discusses the study findings and what they mean for people with HIV.

When did doctors begin to notice a change in cholesterol levels in their HIV patients?
The history of this goes back to about mid-1996, when protease inhibitors, which are one of the classes of HIV medications that we use, became available. About two years later, the first reports emerged about some changes that were being observed. One of the changes was elevations in cholesterol levels and triglyceride levels.

Why is elevated cholesterol a concern for people with HIV?
The concern was that we were making people healthier from an HIV standpoint, but we were creating new problems by putting people at risk for cardiovascular disease. Additionally, elevated triglycerides can cause pancreatitis, a painful inflammation of the pancreas.

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