LIPID AND LIPOPROTEIN LEVELS IN HIV-INFECTED ADULTS WITH SEPSIS COMPARED TO HEALTHY HIV- INFECTED CONTROLS.

ABSTRACT

BACKGROUND: In acute sepsis, reduced lipid and lipoprotein levels occur in HIV negative patients, in particular, low high-density lipoprotein cholesterol (HDL-c) levels are inversely correlated with sepsis severity and increased mortality. However, due to the limited data describing lipid and lipoprotein levels in septic HIV-infected individuals we aimed to investigate the changes in this subgroup. MATERIALS AND METHODS: A prospective cross-sectional observational study of HIV-infected patients comparing admitted HIV - infected patients with sepsis to healthy controls from the antiretroviral therapy (ART) clinic. Non fasting - lipograms, ART use, diagnosis of tuberculosis (TB), markers of infection, renal function and mortality outcome to 3 months post discharge were reviewed. RESULTS: Total cholesterol (TC), low-density lipoprotein (LDL-c) and HDL-c were all significantly lower in the sepsis group (p < 0.001). HDL-c was significantly associated with a higher white cell count (p = 0.018), higher C- reactive protein (p = 0.036) and low serum albumin (p < 0.001). In those with active TB (55%) HDL-c was reduced even further (0.55 vs. 0.72mmol/L, p = 0.013). Acute kidney injury (p = 0.560) and mortality at discharge (p = 0.097) or 3 months follow up (p = 0.953) was not associated with reduced HDL-c. CONCLUSION: Septic HIV-infected patients had significantly reduced lipid and lipoprotein levels at admission. Of note however, a low HDL-c was associated with markers of infection and reductions in HDL-c was more marked in those with active TB.