Author + information
- Franck Boccaraa,b,
- Mathilde Ghislaina,b,
- Laurence Meyera,b,
- Cecile Goujarda,b,
- Cedric Le Maya,b,
- Corinne Vigourouxa,b,
- Jean Philippe Bastarda,b,
- Soraya Fellahia,b,
- Jacqueline Capeaua,b,
- Ariel Cohena,b and
- Bertrand Carioua,b
Background: Mechanisms of HIV-associated dyslipidemia are complex, involving HIV itself and some protease inhibitors (PI). How PCSK9 level is regulated in HIV-infected patients (HIV+) treated with PI has never been investigated.
Methods: Fasting plasma concentrations of PCSK9 were measured using ELISA assay in HIV+ at ART initiation and after one year of PI-based therapy without any disruption. Subjects not virologically suppressed at follow-up, or taking any lipid lowering therapies at baseline or during follow-up were excluded. HIV-uninfected subjects (HIV-) matched on age and sex were included. Spearman's correlation coefficient was used to determine the association between PCSK9 levels and metabolic parameters at baseline and under PI.
Results: 103 HIV+ were enrolled: median age 36 years (IQR 30-45), 76% male. During a median exposure to PI of 14 months (IQR 12-20) most lipid parameters excluding triglycerides (TG) increased during PI exposure: total cholesterol from 4.2 to 5.1 mmol/L, p<0.0001, LDL-C from 2.6 to 3.1 mmol/L, p<0.0001 and HDL-C from 1.1 to 1.2 mmol/L, p=0.001, while PCSK9 level remained stable (280 (IQR 218- 373) vs 283 (IQR 218-381) ng/mL). PCSK9 level at ART initiation was associated with immunodeficiency (CD4 T-cell count <200/mm3, p=0.002), stage C HIV disease and HIV viral load (r=0.24, p=0.01). In PI-treated patients, PCSK9 levels were no longer associated with HIV-related factors but with total cholesterol (r=0.34 with p=0.006), LDL-C (r=0.27, p=0.01), HDL-C (r=0.17, p=0.01) and TG (r=0.20, p=0.05). PSCK9 levels were also associated with glucose parameters. Compared to controls (n= 90), HIV+ had higher levels of PCSK9 at baseline and after PI exposure while they had lower LDLc concentrations.
Conclusions: Plasma PCSK9 concentrations remained stable in HIV+ treated with PI. However, while in ART-naïve patients, PCSK9 levels were mainly related to HIV infection severity, in PI-treated patients they showed the expected correlations with lipid and glucose parameters. Whether the higher levels of PCSK9 found in HIV+ as compared to controls are associated with the known higher risk of coronary heart disease needs further investigations.
Moderated Poster Contributions
Prevention Moderated Poster Theater, Poster Hall, Hall C
Friday, March 17, 2017, 10:15 a.m.-10:25 a.m.
Session Title: The PCSK9 Revolution: New Insights Into Evaluation and Treatment
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1133M-05
- 2017 American College of Cardiology Foundation