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Undetectable HDL Cholesterol

Very low or undetectable HDL cholesterol can be caused by paraprotein interference with the direct homogeneous assay or the development of autoantibodies to apoA1, which is the primary protein in HDL particles. Drug therapy with fibrates, anabolic steroids and thiazolidinediones can also drastically reduce HDL cholesterol. Genetic diseases such as Tangier disease, apoA-1 deficiency and LCAT deficiency are associated with very low HDL cholesterol levels.

More recently, a case study published in the February issue of Clinical Chemistry described a patient with undetectable HDL cholesterol that was associated with Babesiosis microti infection. HDL cholesterol returned to normal following antibiotic therapy and resolution of the infection. The authors suggest that the production of interleukin 10 disturbs lipoprotein metabolism and produces acquired HDL deficiency. However, they acknowledge that undetectable HDL is an unusual finding relative to the numbers of severe sepsis cases. Alternatively, Babesia may directly interfere with HDL cholesterol synthesis.

Bock JL, Senzel L, Spitzer ED and Bifulco W. Undetectable HDL Cholesterol in a Patient with Flu-Like Illness. DOI: 10.1373/clinchem.2016.258616 Published February 2017.

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