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Longitudinal evaluation of lipoprotein-associated phospholipase A2 as a cardiovascular disease-associated biomarker in relation to abacavir therapy

Abstract number: O324

Parra-Ruiz J., Pena-Monje A., Tomas-Jimenez C., Guillot V., Alvarez M., Lopez-Bueno J., Garcia-Garcia F., Hernandez-Quero J.

Objectives: As there exists still some concern about the potential relationship of Abacavir (ABC) and myocardial infarction (MI), and some authors has postulated that the increase in the risk of MI might be caused because of pro-inflammatory state, as increase and decrease of the risk follows quickly the start and resume of ABC, we decided to longitudinally evaluate Lipoprotein-associated phospholipase A2 (Lp-PLA2), a widely accepted marker of vascular inflammation and cardiovascular disease during ABC therapy in HIV patients due the lack of accuracy of other markers as IL6, IL8, hs-CRP or TNFalfa.

Methods: Eleven consecutive HIV-positive patients starting ABC-containing HAART were sampled at 0, 6 and 12 months after the start of ABC. Eleven HIV-positive patients on ABC sparing HAART were individually matched for other potential cardiovascular disease markers as hypertension, sex, age, smoking status, cholesterol and diabetes, and were sampled as controls.

Results: There were 4 women and 7 men in the cases matched against the same proportion of males/females. Median age was 42 years old (32–54) and 42 (30–54) for men in cases and control, respectively and 40 (35–46) and 40 (33–46) for women in cases and controls respectively. Results are depicted in Table 1. Values of LpPLA2 are expressed in ng/mL.

Mean values for every patient at any given time point were higher than clinical cut points established in 2006 (low risk Lp-PLA2 <200 ng/mL). Interestingly, there was an increase in mean LpPLA2 in all four groups 6 months after the change in HAART, followed by a decrease. At 6 months there were no differences in men regarding ABC, but at 12 months there were an increase in men taking ABC whereas there were a decrease in men without ABC (p = 0.02). Women did not show any differences.

Conclusion: There is an increase in Lp-PLA2 during therapy with ABC in men, but because there were no MI during the one year follow-up among the two groups, the mean Lp-PLA2 values are more than 3 times higher than clinical cut points and Lp-PLA2 seems to exhibit a "risk threshold" we cannot rely on LpPLA2 as a cardiovascular marker in our population.

 Mean (range)
 Start6 months12 months
Men   
  ABC614.41 (483.1–812.3)702.9 (582.3–860.9)669.92 (497.3–835.94)
  No ABC653.74 (517.3–778.1)693.6 (615.2–769.5)620.8 (483.1–764.5)
Women   
  ABC535.7 (450.9–661.6)548.8 (480.9–670.2)566.83 (483.8–685.94)
  No ABC644.6 (503.1–763.8)646.4 (542.3–723.4)652.72 (472.3–806.6)

Session Details

Date: 10/04/2010
Time: 00:00-00:00
Session name: Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Vienna, Austria, 10 - 13 April 2010
Presentation type:
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