Coronary artery calcification, atherogenic lipid changes, and increased erythrocyte volume in black injection drug users infected with human immunodeficiency virus-1 treated with protease inhibitors

Background: Protease inhibitors (PIs) may be associated with accelerated atherosclerosis in individuals infected with human immunodeficiency virus (HIV). We assessed the effects of HIV PIs on subclinical atherosclerosis. Methods: The lipid profiles, C-reactive protein (CRP) levels, coronary artery calcification (CAC) scores, and blood cell morphologic changes were quantified in 98 black adult participants, aged 25 to 45 years, with HIV-1 infection in Baltimore, Md. Fifty-five participants (56.1%) were taking PIs; 43 participants (43.9%) were not. The Student t and x² tests were used as a means of detecting the between-group differences. Results: Participants in both the PI and non-PI groups were similar in age, sex, body mass index, blood pressure, heart rate, and red and white blood cell counts. Compared with the non-PI group, the PI group had significantly higher serum total cholesterol (4.8 ± 1.0 vs 3.8 ± 0.7 mmol/L, P < .001) and LDL cholesterol (2.9 ± 0.8 vs 2.1 ± 0.7 mmol/L, P < .001) levels and red blood cell mean corpuscular volume (92.2 ± 9.3 vs 86.8 ± 7.2 μm³, P = .048). The CAC scores in the PI group were also higher than those in the non-PI group (11.0 ± 28.6 [n = 43] vs 1.7 ± 5.8, P = .043). CAC scores were marginally associated with log-transformed duration of the PI therapy (P = .055). Serum CRP levels remained unchanged (5.5 ± 13.6 mg/L [n = 45] vs 3.9 ± 5.5 mg/L, P = .467). Serum total cholesterol level, LDL cholesterol level, red blood cell mean corpuscular volume, and CAC scores were indicated by means of regression analyses to be associated with log-transformed duration of the PI therapy. Conclusions: The use of PIs is associated with coronary artery calcification, atherogenic lipid changes, and increased erythrocyte volume in individuals infected with HIV-1.