Serum lipid concentration with reference to the clinical and immunological status of HIV infected men.

We investigated the serum concentrations of free fatty acids (FFA), cholesterol, phopholipids and triglycerides in HIV-positive men (n = 50) from three behaviour groups: heterosexuals (n = 16), drug addicts (n = 18) and homosexuals (n = 16) and a control group of HIV-negative men (n = 25). The circulating concentrations of lipids were analyzed with reference to the clinical status of infection and the absolute CD4 cell count. According to the clinical progression of HIV infection the patients were divided into two groups (CDC 1987 criteria): stages II and III (n = 28) and stage IVC (n = 22). HIV-positive men had higher polyunsaturated fatty acids (PUFA) (+100%), p < 0.001) only in the II and III stages, lower cholesterol (-25% to -40%, p < 0.001) and lower phospholipids (-25%, p < 0.001) for the two stages than in the controls. The triglycerides were increased only in stage IVC patients compared to the controls (+110%, p < 0.001). According to their CD4 cell count, the patients were divided into four groups: > 400 (n = 11), 400-150 (n = 9), 150-50 (n = 9) and < 50 (n = 19). Regardless of the CD4 count, the PUFA were significantly higher (+50% to +125%) and cholesterol (-35% to -45%) and phospholipids (-25% to -30%) lower than in the controls in all HIV-infected men except the patients with 400-150 CD4. Only the HIV-positive patients with < 50 CD4 cells had elevated triglycerides (+97%, p < 0.001). There was a significant negative correlation between the CD4 cell count and the serum triglyceride concentrations (r = -0.31, p < 0.03). In conclusion, the most elevated PUFA occurred in HIV-positive patients with > 400 CD4, while hypertriglyceridaemia is prevalent in very advanced stages of infection (with < 50 CD4). This suggests that there is a relationship between the circulating PUFA and triglycride levels and the progression of infection and immune suppression. The disturbances in lipid metabolism must now be correlated with the underlying metabolic, hormonal and cytokine changes and their role in the development of significant malnutrition and immune perturbations.