CATIE News

18 August 2020 

HIV-positive women found to have low levels of good cholesterol and high levels of smoking

  • Canadian researchers found more cardiovascular risk factors among women with HIV
  • Two-thirds of HIV-positive women in the study had abnormal levels of lipids in the blood
  • This may be linked to lower levels of good cholesterol and higher rates of smoking

HIV infection causes many changes to key organs and systems. These changes are mostly normalized with continued use of effective treatment (ART), but some abnormalities persist.

A team of scientists at the University of British Columbia in Vancouver and the Children’s Hospital of Eastern Ontario in Ottawa cooperated in a study on the metabolic health of women and girls living with HIV. The researchers found that HIV infection was associated with an increased risk for abnormal lipids (cholesterol and triglycerides) in their blood. However, HIV was not associated with an increased risk for diabetes, higher-than-normal blood pressure or excess weight. Many HIV-positive women in the study smoked and the researchers encouraged healthcare providers to provide support for smoking cessation in this population, as smoking is associated with many harms, including an increased risk for cardiovascular disease.

Study details

The present study was a sub-study of a larger study called CARMA. The larger study is ongoing and seeks to assess changes in women with and without HIV infection as they age.

Researchers were able to collect health-related information when women enrolled in the study by interview, blood tests and other assessments. Enrollment took place between January 2013 and August 2017. A total of 289 female participants were recruited—both women and girls (girls had to be at least 12 years old to be considered for the study). There were 133 HIV-positive and 156 HIV-negative participants. Their average profile at the start of the study was as follows:

  • age – 44 years (range from 13 to 69 years)
  • major ethno-racial groups: White – 49%; Indigenous – 19%; Black or Caribbean – 15%
  • 29% had entered menopause
  • 25% were current smokers

HIV specific factors

  • current CD4+ cell count – 570 cells/mm3
  • lowest-ever CD4+ count – 190 cells/mm3
  • 92% of women were taking ART

Results

The researchers did not find any increased risk for diabetes among the HIV-positive women. Also, using a common cardiovascular risk calculator called the Framingham risk score, they found that the cardiovascular risk was not elevated in the HIV-positive group. Note that other, larger studies have reported that cardiovascular risk calculators were developed using data from HIV-negative people and may not be as useful in HIV-positive people.

Higher-than-normal blood pressure (hypertension)

Rates of higher-than-normal blood pressure were not different between HIV-negative and HIV-positive women. However, the researchers found that regardless of HIV status women of African, Caribbean or Black heritage were more likely to have hypertension. Other studies in HIV-negative people have found that people of African ancestry have an increased risk of hypertension.

There was a trend between increased CD4+ cell counts and hypertension. However, the researchers suggested that this link was likely a reflection of the weight gain that tends to accompany higher CD4+ cell counts (and overall improved health) in people on ART.

Abnormal lipid levels

The researchers found that nearly 67% of HIV-positive women in the study had abnormal levels of lipids in their blood. In most cases this was caused by abnormally low levels of good cholesterol (HDL-C). Although at the time of the analysis the overall risk for heart attack and stroke was low, the researchers are concerned that over time the cardiovascular risk in these women “is likely to increase substantially.”

Cardiovascular risk is driven by many factors, including inflammation associated with HIV. Studies in men have found that HIV infection causes abnormalities in cholesterol levels. These abnormalities are only partially corrected with ART. For instance, though ART reduces inflammation, it never falls to the levels seen in healthy, HIV-negative people. Furthermore, after the initiation of ART, low levels of HDL-C do not usually return to the range seen in healthy, HIV-negative men.

Other drivers of cardiovascular risk can include excess belly fat, not enough physical activity, substance use (including smoking), poor dietary habits and so on.

Tobacco use

The researchers found that HIV-positive women were more likely to smoke tobacco than HIV-negative women. Smoking increases the risk for developing abnormal lipid levels and for a cluster of factors linked to poor cardiovascular health. Smoking also causes cancer. Not surprisingly, other studies have found that HIV-positive people who smoke have reduced life expectancy.

Aging

For decades, scientists have noticed that some HIV-positive people appear to have accelerated aging. In the present study, HIV-positive women tended to have one marker of increased cellular aging compared to HIV-negative women. However, there did not seem to be any physical or other effects of this.

For the future

The findings from the CARMA sub-study underscore the importance of screening HIV-positive women for tobacco use and offering support for quitting to those who smoke tobacco. The researchers also encouraged healthcare providers to ensure “aggressive control of lipids” when providing care for HIV-positive women.

The present analysis was done at only one point in time. It would be great if the CARMA study received more and longer-term funding so that it could recruit additional women and monitor them as they grow older.

–Sean R. Hosein

Resources

B.C. study finds that HIV-positive women are likely to have other health conditionsCATIE News

Amenorrhea linked to bone loss in HIV-positive womenCATIE News

Delays in cervical cancer screening among some HIV-positive Canadian womenCATIE News

Canadian study finds HPV vaccine beneficial for HIV-positive womenCATIE News

Insufficient food linked to inflammation in HIV-positive womenCATIE News

Canadian study examines why some women fall out of the HIV care cascadeCATIE News

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