Lipoprotein levels and cardiovascular risk in HIV-infected and uninfected Rwandan women

Cross-sectional study of 824 (218 HIV-negative, 606 HIV+) Rwandan women. Body composition by body impedance analysis, CD4 count, and fasting serum total cholesterol (total-C), triglycerides (TG) and high-density lipoprotein (HDL) levels were measured. Low-density lipoprotein (LDL) was calculated from Friedewald equation if TG < 400 and measured directly if TG ≥ 400 mg/dl.BMI was similar in HIV+ and -negative women, < 1% were diabetic, and HIV+ women were younger. In multivariate models LDL was not associated with HIV-serostatus. HDL was lower in HIV+ women (44 vs. 54 mg/dL, p < 0.0001) with no significant difference by CD4 count (p = 0.13). HIV serostatus (p = 0.005) and among HIV+ women lower CD4 count (p = 0.04) were associated with higher TG. BMI was independently associated with higher LDL (p = 0.01), and higher total body fat was strongly associated with higher total-C and LDL. Framingham risk scores were < 2% in both groups.In this cohort of non-obese African women HDL and TG, but not LDL, were adversely associated with HIV infection. As HDL is a strong predictor of cardiovascular (CV) events in women, this HIV-associated difference may confer increased risk for CV disease in HIV-infected women.Dyslipidemias have been described since 1989 in individuals with human immunodeficiency virus (HIV) infection in resource-replete countries, prior to the availability of combination antiretroviral therapy (cART), in studies primarily of white men [1-6]. Quantitative abnormalities include higher triglyceride levels (TG) [2-6] and lower levels of total cholesterol (total-C) [1,5-7], high-density lipoprotein (HDL) [3,6,8] and low-density lipoprotein (LDL) [1-7,9] cholesterol. These abnormalities are greater with more advanced immune suppression [2-6]. Patterns of lipoprotein changes are somewhat different in HIV-infected women [10], with most studies showing no association of HIV-infection with lower LDL. Both women and African Americans in general have higher HDL and lowe