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Protease inhibitor related type III hyperlipoproteinaemia is common and not associated with apolipoprotein-E E2/E2 phenotype
  1. Mohsen Shahmanesh1,
  2. Henna Jaleel1,
  3. Yassus DeSilva1,
  4. Jonathan D C Ross1,
  5. Muriel Caslake3,
  6. Robert Cramb2
  1. 1Department of Genitourinary Medicine, University Hospital Birmingham NHS Trust, Selly Oak Hospital, Birmingham, UK
  2. 2Department of Clinical Biochemistry
  3. 3Department of Pathological Biochemistry, Glasgow, UK
  1. Dr Mohsen Shahmanesh, Department of Genitourinary Medicine, Whittall Street Clinic, Whittall Street, Birmingham B4 6DH, UK mohsen.shahmanesh{at}


Objective: To determine the prevalence of type III hyperlipoproteinaemia in a cohort of HIV infected patients taking protease inhibitors and its correlation with the apolipoprotein-E2 isoform.

Design: Cross sectional study of 57 consecutive HIV infected subjects taking protease inhibitor therapy for a median of 12.5 (1–29) months, seen in an outpatient HIV clinic. Controls were 17 patients on non-nucleoside reverse transcriptor inhibitor therapy (NNRTI) for 9 (1–19) months and 50 antiviral naive patients.

Methods: Fasting cholesterol, triglyceride, HDL cholesterol, lipoprotein (a), and glucose were measured. Lipoprotein electrophoresis was performed on patients with a cholesterol >6.5 mmol/l and a triglyceride concentration of >4.5 mmol/l. Apolipoprotein-E phenotype was determined in serum.

Results: Dyslipidaemia was found in 43 (75%) PI treated patients—37 with triglyceride >2.3 mmol/l, 30 with cholesterol >6.5 mmol/l, and nine with HDL cholesterol <0.9 mmol/l. 38% had a lipoprotein (a) >300 mg/l. 11 patients (19.3%) had a type III hyperlipoproteinaemia pattern. Only one was homozygous for the E2 phenotype and none had clinical diabetes. An additional patient had a serum lipid profile compatible with type III hyperlipoproteinaemia and an E3/E2 phenotype in whom electrophoresis was not carried out before treatment. Six (35%) of the NNRTI and 16 (32%) of the antiviral naive patients had dyslipidaemia. 18 (31.6%) of the PI and none of the control patients had a cholesterol and/or triglyceride >8 mmol/l.

Conclusion: Type III hyperlipoproteinaemia is common in this group of patients and need not be associated with the apolipoprotein-E2/E2 isoform. HIV protease inhibitors may interfere with lipoprotein receptor related protein.

  • HIV
  • protease inhibitors
  • hyperlipidaemia
  • apolipoprotein-E

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