Effect of antiretroviral therapy on allele-associated Lp(a) level in women with HIV in the Women's Interagency HIV Study

J Lipid Res. 2018 Oct;59(10):1967-1976. doi: 10.1194/jlr.P084517. Epub 2018 Jul 16.


We previously demonstrated an association between lipoprotein (a) [Lp(a)] levels and atherosclerosis in human immunodeficiency virus (HIV)-seropositive women. The effects of antiretroviral therapy (ART) on Lp(a) levels in relation to apo(a) size polymorphism remain unclear. ART effects on allele-specific apo(a) level (ASL), an Lp(a) level associated with individual apo(a) alleles within each allele-pair, were determined in 126 HIV-seropositive women. ART effects were tested by a mixed-effects model across pre-ART and post-ART first and third visits. Data from 120 HIV-seronegative women were used. The mean age was 38 years; most were African-American (∼70%). Pre-ART ASLs associated with the larger (4.6 mg/dl vs. 8.0 mg/dl, P = 0.024) or smaller (13 mg/dl vs. 19 mg/dl, P = 0.041) apo(a) sizes were lower in the HIV-seropositive versus HIV-seronegative group, as was the prevalence of a high Lp(a) level (P = 0.013). Post-ART ASL and prevalence of high Lp(a) or apo(a) sizes and frequency of small size apo(a) (22 kringles) did not differ between the two groups. ART increased Lp(a) level (from 18 to 24 mg/dl, P < 0.0001) and both ASLs (P < 0.001). In conclusion, regardless of genetic control, Lp(a) can be modulated by HIV and its treatment. ART initiation abrogates HIV-induced suppression of Lp(a) levels and ASLs, contributing to promote CVD risk in HIV-seropositive individuals.

Keywords: apolipoprotein (a) sizes; apolipoproteins; biomarkers; clinical studies; drug therapy; human immunodeficiency virus treatment; lipoprotein (a); lipoproteins; longitudinal design; molecular biology/genetics; prospective cohort.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Alleles*
  • Anti-HIV Agents / pharmacology*
  • Anti-HIV Agents / therapeutic use
  • Apoprotein(a) / blood
  • Cohort Studies
  • Female
  • HIV Seropositivity / blood*
  • HIV Seropositivity / complications
  • HIV Seropositivity / drug therapy*
  • HIV Seropositivity / genetics
  • Hepatitis C / complications
  • Humans
  • Lipoprotein(a) / blood*
  • Phenotype
  • Risk
  • Treatment Outcome


  • Anti-HIV Agents
  • Lipoprotein(a)
  • Apoprotein(a)