Abstract Body: Introduction: The risk of atherosclerotic cardiovascular disease (ASCVD) is elevated in people with HIV despite effective antiretroviral therapy. Lipoprotein(a) (Lp[a]) is an acute phase reactant and pro-inflammatory ASCVD risk factor that could potentially contribute to excess ASCVD risk in people with HIV, who have chronic inflammation. However, Lp(a) levels in this population have not been thoroughly investigated.
Research Aim: Determine if people with HIV are more likely to have high Lp(a) than people without HIV.
Methods: In UK Biobank participants aged 40–69 years (recruited 2006–2010) with serum Lp(a) measured using isoform-insensitive immunoturbidimetry, we examined the prevalence of high Lp(a), defined as ≥125 nmol/L. We compared the prevalence of high Lp(a) by HIV status using prevalence differences (PDs) estimated from generalized linear models, adjusted for age, sex, and ancestry. We also conducted a subgroup analysis stratified by African vs. European ancestry.
Results: We examined 458 people with HIV and 451,548 without HIV. Compared to those without HIV, people with HIV were younger (median [IQR] age 50 [45, 57] vs. 58 [50, 63] years) and more likely to be male (86% vs. 46%) and of African ancestry (18% vs. 2%). Median Lp(a) levels (IQR) were 27 nmol/L (8, 102) for people with HIV and 20 nmol/L (8, 75) for those without HIV. In unadjusted analyses, people with HIV were more likely to have high Lp(a), with a prevalence of 20.5% (95% CI 16.8%, 24.2%) compared to 16.4% (16.3%, 16.5%) in those without HIV, a PD of 4.1 percentage points (0.4, 7.8) (Figure). The adjusted PD comparing people with vs. without HIV was 4.5 percentage points (0.9, 8.1). Among people of African ancestry, the unadjusted prevalence of high Lp(a) was 32.5% (22.2%, 42.8%) in those with HIV and 27.1% (26.1%, 28.0%) in those without HIV. Among people of European ancestry, unadjusted prevalence was 17.7% (13.7%, 21.8%) and 16.5% (16.4%, 16.6%) in those with and without HIV, respectively. Stratified PDs were similar to the overall findings (Figure).
Conclusions: People with HIV were more likely than those without HIV to have Lp(a) levels above the risk-enhancing threshold of 125 nmol/L, even when accounting for age, sex, and ancestry. Clinicians should consider Lp(a) screening in people with HIV to inform ASCVD prevention efforts. Future studies should investigate reasons for high Lp(a) in some people with HIV and potential benefit of Lp(a)-lowering therapies in this population.