Niacin in HIV-Infected Individuals with Hyperlipidemia Receiving Potent Antiretroviral Therapy

Abstract

Background. Extended release (ER)-niacin therapy, which has been associated with reduced glucose tolerance in human immunodeficiency virus (HIV)-seronegative individuals, has not been evaluated in the HIV-infected population.Methods. This open, prospective trial evaluated the safety and efficacy of ER-niacin therapy for antiretroviral therapy-associated dyslipidemia. Fourteen individuals received ER-niacin at maximum doses of 2000 mg per day for 14 weeks.Results. Significant reductions in serum levels of triglycerides ( ), total cholesterol ( ), and P p .02 P p .005 non-HDL cholesterol ( ) were seen after ER-niacin therapy. Seven of 11 subjects were glucose intolerant P p .04 after ER-niacin therapy; for 3 of these subjects, this was a new finding. b-Cell sensitivity to basal glucose levels increased significantly without concomitant increase in overall glucose disposition indices. The values for the homeostasis model of insulin resistance index increased significantly ( ). P p .005 Conclusion. ER-niacin's role in the treatment of antiretroviral therapy-associated dyslipidemia requires further evaluation, but the results of this pilot study indicate that it is safe and tolerated and provides a valuable treatment option.

Metabolic abnormalities in HIV-infected patients: An update

“…Similar findings were observed in a 16-week trial of fish oil supplements (1750 mg EPA and 1150 mg DHA per day) [20]. Extended-release niacin was also found to reduce TGs by a median of 34% after 14 weeks in a small pilot study [21]. In a larger study, extended-release niacin (2000 mg/d) decreased TGs by an average of 38% and increased HDL cholesterol by 15%.…”

Coronary heart disease in HIV-infected patients

“…In a pilot dose escalation study, an extended release formulation of niacin lowered triglycerides, total cholesterol, and non-HDL cholesterol significantly over a 14-week period [40]. Insulin sensitivity was reduced, but none of the 14 subjects developed overt diabetes mellitus.…”

Lipid Management in Human Immunodeficiency Virus

“…Seven were glucose intolerant; this was a new finding for 3 of the 7. 101 In the open-label ACTG A5148 trial, extended-release niacin was used in escalating doses for up to 44 weeks to treat hypertriglyceridemia and resulted in a median decrease in TG of 38%. 100 Niacin is not a potent LDL-C-lowering medication, and treatment of hypertriglyceridemia requires high doses.…”