Reduction in Triglyceride Level With N-3 Polyunsaturated Fatty Acids in HIV-Infected Patients Taking Potent Antiretroviral Therapy

Abstract

To assess the evolution of triglyceride (TG) levels in HIV-infected patients receiving stable potent antiretroviral therapy treated with N-3 polyunsaturated fatty acids (PUFAs), a prospective double-blind randomized design for a reliable assessment of TG evolution was performed. One hundred twenty-two patients with TG levels >2 g/L and < or =10 g/L after a 4-week diet (baseline TG: 4.5 +/- 1.9 g/L) were randomized for 8 weeks to N-3 PUFAs (2 capsules containing 1 g of fish oil 3 times daily, n = 60), or placebo (1 g of paraffin oil capsules, n = 62). An 8-week open-label phase of N-3 PUFAs followed. Evaluation criteria were TG percent change at week 8, percentage of responders (normalization or > or =20% TG decrease), and safety issues. Ten patients with baseline TG levels >10 g/L were not randomized and received N-3 PUFAs as open treatment. The difference (PUFA - placebo) in TG percent change at week 8 was -24.6% (range: -40.9% to -8.4%; P = 0.0033), the median was -25.5% in the PUFA group versus 1% in the placebo group, and mean TG levels at week 8 were 3.4 +/- 1.8 g/L and 4.8 +/- 3.1 g/L, respectively. TG levels were normalized in 22.4% (PUFA) versus 6.5% (placebo) of patients (P = 0.013) with a > or =20% reduction in 58.6% (PUFA) versus 33.9% (placebo) of patients (P = 0.007). Under the open-label phase of N-3 PUFAs, the decrease in TG levels was sustained at week 16 for patients in the PUFA group (mean TG: 3.4 +/- 1.7 g/L), whereas a 21.2% decrease in TG levels occurred for patients in the placebo group (mean TG: 3.3 +/- 1.4 g/L). No significant differences were observed between groups in the occurrence of adverse events. The median TG change at week 8 was -43.6% (range: Q1-Q3; 95% CI: -66.5% to -4.6%) for patients with baseline TG levels >10 g/L. The difference in mean total cholesterol between groups (PUFA - placebo) at week 8 was -8.5% (P = 0.0117). This study demonstrated the efficacy of PUFAs to lower elevated TG levels in treated HIV-infected hypertriglyceridemic patients. N-3 PUFAs have a good safety profile.

Terapia nutricional nas alterações metabólicas em pessoas vivendo com HIV/aids

“…Intraevaluator and interevaluator reliability as well as measures of association were not reported in the articles. Dyslipidemia was reported in all studies, 1,2,4,8,[16][17][18] lipodystrophy / body composition changes in two, 1,8 and insulin resistance / glucose intolerance 1 and hypertension 8 in one (Table 1). …”

“…Of the seven studies included, four were conducted in the United States, 8,17,18 two in Canada, 1,2 one in France, 16 and one in Australia. 4 They were published from 2005 to 2009 (Table 1).…”

“…Two were randomized, controlled and double blind studies, 1,4 two were randomized cross-over, 2,16 and three were randomized controlled trials. 8,17,18 (Table 1).…”

“…Lost-to-follow-up was reported in six studies. 1,2,4,8,16,17 The follow-up period ranged from 13 weeks to six months (Table 1).…”

“…Diet was used in an attempt to equate the intervention group (IG) and controls before implementing the intervention being tested. 4,16 Food supplements included chromium nicotinate and omega 3. Omega 3 was tested in fi ve studies, with doses ranging from 3 g to 9 g/day ( Table 1).…”