Rate of Dyslipidemia Higher Among Women Living With HIV

A Comparison of Metabolic and Cardiovascular Health in a Cohort to Study Aging in HIV

EAB Russell; AYK Albert; HCF Côté; AYY Hsieh; A Nesbitt; AR Campbell; EJ Maan; J Brophy; N Pick; MCM Murray


HIV Medicine. 2020;21(7):418-428. 

In This Article

Abstract and Introduction


Objectives: Combination antiretroviral therapy has largely restored the lifespan of persons living with HIV. Data suggest early comorbidities of aging in this population. Past studies focused on men; limited data exist regarding the prevalence of dyslipidaemia in women living with HIV (WLWH). We investigated the prevalence of cardiometabolic abnormalities among WLWH and HIV-negative women in the Children and Women: Antiretrovirals and Markers of Aging (CARMA) cohort, and their relationships to cellular aging markers.

Methods: We conducted a cross-sectional analysis of nonpregnant female patients (156 WLWH and 133 HIV-negative controls, aged 12–69 years) enrolled in CARMA between 2013 and 2017. The Framingham risk score (FRS) and the prevalences of hypertension, diabetes, metabolic syndrome and dyslipideamia were determined using self-report, anthropometrics, chart review and laboratory data. Cellular aging was determined by assessing leukocyte telomere length and blood mitochondrial DNA content. Diagnoses were based on current Canadian guidelines and definitions.

Results: HIV-infected status was associated with dyslipidaemia [odds ratio (OR) 2.89; 95% confidence interval (CI) 1.69–5.01], but not diabetes, higher FRS, hypertension or metabolic syndrome. The median age was 43.5 [interquartile range (IQR) 36.8–50.9] years in WLWH and 46.2 (IQR 30.3–54.9) years in HIV-negative controls. WLWH were less likely to be menopausal or use alcohol, and more often had hepatitis C virus infection or a current or past smoking history. Lower mitochondrial DNA content was associated with metabolic syndrome; no other associations were noted between cardiometabolic abnormalities and markers of cellular aging.

Conclusions: Despite their relatively young age, almost two-thirds of WLWH had dyslipidaemia, a significantly greater proportion than in controls. Strategies to address dyslipidaemia and decrease smoking rates may improve long-term outcomes among WLWH.


In 2018, there were 36.9 million people living with HIV, 18.2 million of whom were women.[1] Combination antiretroviral therapy (cART) has improved the lifespan of persons living with HIV (PLWH).[2] As long-term survival increases, PLWH may be more likely to have metabolic and cardiovascular abnormalities such as diabetes,[3] cardiovascular disease,[4] hypertension,[5] metabolic syndrome,[3,6] and dyslipidaemia.[3] Moreover, although persons receiving cART have fewer AIDS-related diseases than cART-naïve PLWH overall,[2,4] exposure to cART, particularly protease inhibitors (PIs), may increase the risk of cardiometabolic disease.[3,4,7–9]

Studies thus far, mainly in men, have shown mixed results regarding the relationship between HIV status and metabolic and cardiovascular diseases.[3–14] Among studies of women living with HIV (WLWH), one study showed no significant difference in diabetes incidence between WLWH and HIV-negative women,[14] while another reported a lower prevalence of hypertension but an increased risk of cardiovascular disease in WLWH compared to HIV-negative women.[11] Blood pressure (BP), waist circumference and the prevalence of metabolic syndrome all increased in the first 3 years after HIV infection (before cART initiation) in a study of South African women.[6] Data regarding the prevalence of dyslipidaemia in WLWH compared to HIV-negative women are currently lacking.

Blood mitochondrial DNA content (mtDNA:nuclear DNA ratio) and leukocyte telomere length (LTL) are markers of cellular aging, and have been associated with many of the above-mentioned diseases.[15,16] In a Danish longitudinal study, relative blood mtDNA content decreased with age, and lower mtDNA was independently associated with higher all-cause mortality.[16] Telomere length reflects the remaining replicative ability of cells, and shorter LTL has been related to type 2 diabetes, cardiovascular disease, hypertension, metabolic syndrome and dyslipidaemia in HIV-negative individuals.[17]

Women have longer LTL and lifespans than men,[18] suggesting a more active protective mechanism against telomere shortening, such as an antioxidant effect of oestrogen.[19] In addition, oestrogen stimulates the expression of telomerase, which prevents telomere attrition.[19] The effects of oestrogen may partially explain why age-related diseases such as cardiovascular disease are more common in men than women, a difference that disappears in postmenopausal women.[19]

Women living with HIV show signs of accelerated aging and experience menopause at a younger age compared to HIV-negative women.[20] As data comparing age-related comorbidities and cellular markers of aging are rare among WLWH, we herein investigated the prevalence of cardiometabolic disease, and its predictors, among WLWH and HIV-negative women participating in the Children and Women: Antiretrovirals and Markers of Aging (CARMA) cohort study. We further examined how differences between the groups might be influenced by clinical, social and demographic factors.