Dyslipidemia and Cardiovascular Disease Risk Factor Management in HIV-1-Infected Subjects Treated with HAART in the Spanish VACH Cohort

Domingo Pere *, 1 , Suarez-Lozano Ignacio 2, Teira Ramón 3, Lozano Fernando 4, Terrón Alberto 5, Viciana Pompeyo 6, González Juan 7, Galindo Mª José 8, Geijo Paloma 9, Vergara Antonio 10, Cosín Jaime 11, Ribera Esteban 12, Roca Bernardino 13, Garcia-Alcalde Mª Luisa 14, Sánchez Trinitario 15, Torres Ferran16, Lacalle Juan Ramón 17, Garrido Myriam 18
1 Hospital de la Santa Creu i Sant Pau
2 H. I. Elena–Huelva
3 H. de Basurto-Bilbao
4 H. de Valme-Sevilla
5 H. Clinico Puerto Real
6 H. V. del Rocío-Sevilla
7 H. La Paz-Madrid
8 H. Clinico-Valencia
9 H. V de la Luz-Cuenca
10 H. SAS-Jerez
11 H. Gregorio Marañon-Madrid
12 H. Vall D´hebron-Barcelona
13 H. General de Castellon
14 H. de Cabueñes-Asturias
15 H. V. del Rosell-Cartagena
16 Dpto. de Estadística, Facultad de Medicina, Universitat Autònoma de Barcelona
17 Dpto. Estadística, Facultad de Medicina Universidad Sevilla
18 Data Management VACH Group

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* Address correspondence to this author at the Infectious Diseases Unit, Hospital de la Santa Creu I Sant Pau, Av. Sant Antoni Mª Claret, 167, 08025, Barcelona, Spain; Tel: +34935565609; Fax: + 34935565938; E-mail: or



There is increasing evidence that metabolic adverse effects associated with antiretroviral therapy may translate into an increased cardiovascular risk in HIV-1-infected patients.


To determine the prevalence of risk factors for cardiovascular disease (CVD) among HIV-1-infected persons, and to investigate any association between them, stage of HIV-1 disease, and use of antiretroviral therapies.


Multicentric, cross-sectional analysis of CVD risk factors of treated patients in the VACH cohort. The data collected includes: demographic variables, cigarette smoking, diabetes mellitus, hypertension, dyslipidemia, body mass index, stage of HIV-1 infection, and antiretroviral therapy.


The analysis included 2358 patients. More than 18% of the study population was at an age of appreciable risk of CVD. 1.7% had previous CVD and 59.2% were smokers. Increased prevalence of elevated total cholesterol was observed among subjects receiving an NNRTI but no PI [odds ratio (OR), 3.34; 95% confidence interval (CI), 1.77–6.31], PI but no NNRTI (OR, 4.04; 95% CI, 2.12–7.71), or NNRTI + PI (OR, 17.77; 95% CI, 7.24–43.59) compared to patients treated only with nucleoside reverse transcriptase inhibitors (NRTI). Higher CD4 cell count, lower plasma HIV-1 RNA levels, clinical signs of lipodystrophy, longer exposure times to NNRTI and PI, and older age were all also associated with elevated cholesterol levels. The use of lipid lowering agents was very low among our patients.


Patients in the VACH cohort present multiple known risk factors for CVD, and a very low rate of lipid lowering therapy use. NNRTI and/or PI-based antiretroviral therapies are associated with the worst lipid profile. This is more frequent in older subjects with greater CD4 counts and controlled HIV-1 replication.

Keywords: HIV-1 infection, antiretroviral therapy, HIV-1 protease inhibitors, non nucleoside reverse transcriptase inhibitors, dyslipidemia, cardiovascular risk, coronary heart disease, VACH..