Association of immune recovery with hyperlipidaemia and apolipoprotein gene polymorphisms following highly active antiretroviral therapy in a cohort of Chinese HIV patients

BMJ Open. 2016 Apr 11;6(4):e010998. doi: 10.1136/bmjopen-2015-010998.


Objective: To examine the associations between CD4 recovery, dyslipidaemia and apolipoprotein (APO) gene single nucleotide polymorphisms (SNPs) following highly active antiretroviral therapy (HAART).

Design: Retrospective observational cohort study.

Setting: A major HIV care clinic in Hong Kong.

Participants: 197 Chinese treatment-naïve HIV patients.

Outcome measures: Maximum CD4 count and its rise 2-3 years after HAART initiation and their association with abnormal total cholesterol (TC), triglyceride (TG) and 8 selected APO SNP at multiple time points.

Results: Before HAART, abnormal levels of TC, TG, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were detected in 13%, 26%, 59% and 19% of the recruited patients, respectively. APOA5 -1131T>C and c.553G>T were significantly associated with high pre-HAART TG while APOE 2198C>T was correlated with high TG at baseline and/or a rise 2-3 years following HAART initiation. Poor CD4 achievement, defined as the highest CD4 count <350/μL and a net gain of <100/μL, was associated with a low CD4 count ≤200/μL at baseline and a rise of TC beyond 5.17 mmol/L following HAART with or without the use of antilipid agents. Conversely, satisfactory CD4 achievement was associated with APOC3 3238GG genotype. Applying a linear generalised estimating equation, APOA5 -1131T>C was shown to be a predictor of a weaker temporal trend for CD4 response in the presence of a low baseline CD4≤200/μL.

Conclusions: Dyslipidaemia plays a predictive role in impacting immunological recovery following HAART, which could be partly explained by the APO gene SNP.


Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active*
  • Apolipoprotein A-V / blood
  • Apolipoprotein A-V / genetics*
  • Asian People / genetics
  • CD4 Lymphocyte Count
  • China
  • Cholesterol / blood
  • Female
  • HIV Infections / blood
  • HIV Infections / complications
  • HIV Infections / drug therapy
  • HIV Infections / immunology*
  • Hong Kong
  • Humans
  • Hyperlipidemias / blood
  • Hyperlipidemias / complications*
  • Hyperlipidemias / genetics
  • Hyperlipidemias / immunology
  • Lipids / blood*
  • Lipids / genetics
  • Male
  • Polymorphism, Single Nucleotide*
  • Retrospective Studies
  • Triglycerides / blood


  • Anti-HIV Agents
  • Apolipoprotein A-V
  • Lipids
  • Triglycerides
  • Cholesterol