Use of metabolic drugs and fish oil in HIV‐positive patients with metabolic complications and associations with dyslipidaemia and treatment targets

Abstract

BackgroundHighly active antiretroviral therapy (HAART) with protease inhibitors (PI) is successful in suppressing viral replication, but may lead to a range of metabolic abnormalities associated with cardiovascular disease (CVD). ObjectivesThe first objective of the study was to compare baseline demographic and clinical characteristics between PI users and non-PI users referred to a specialized metabolic clinic during [1999][2000][2001][2002][2003]. The second objective was to assess the associations of prescription drugs and fish oil with dyslipidaemia and to determine whether or not patients achieved treatment targets during 6 months of treatment. MethodsA retrospective analysis was performed using two sets of charts based on standardized forms with entries for personal data, drug treatment and clinical history. Anonymous linkage with the British Columbia HIV/AIDS Drug Treatment Program and the hospital laboratory was performed to gather information about HAART prescriptions and blood work. ResultsIn total, 237 patients were included in the study. There were few differences in any demographic or clinical factors between PI users and non-PI users. Compared with controls not taking lipid-lowering drugs or fish oil (n 5 48), statins appeared to be the only agent that was significantly associated with a reduced total cholesterol concentration ( À 15.6%; P 5 0.009). Fibrate treatment was associated with the largest reduction of triglyceride concentration ( À 37.4%; P 5 0.012), closely followed by fish oil (n 5 18; À 32%; P 5 0.027). Six-month treatment success rates ranged between 17 and 43% of patients for total cholesterol (o5.2 mmol/L) and between 15 and 44% of patients for triglycerides (o2.3 mmol/L). ConclusionsDespite the apparent lowering of blood lipids with drug and fish oil treatments, a majority of patients in these treatment groups (56.5-83.3%) still had elevated concentrations after 6 months. expectancy in HIV-positive men and women [2]. Although HAART regimens are able to suppress viral replication, there is evidence that some antiretroviral drugs are associated with a range of metabolic abnormalities that lead to cardiovascular disease (CVD) [3][4][5][6][7][8][9]. Numerous population-based cohort studies have suggested that some protease inhibitors (PIs) are more strongly associated with dyslipidaemia than others [10,11]. For example, hypertriglyceridaemia appears to be more frequent and more severe with ritonavir than with indinavir. In addition, the use of PIs has also been shown to more frequently result in endothelial dysfunction [12] and coronary artery calcification [13]. CVD may be caused by accelerated atherosclerosis [12,14] resulting from side effects of antiretroviral therapy (ART) such as dyslipidaemia, insulin resistance and lipodystrophy [15]. Compared with the general population of a similar age, HIV-positive patients have a lower prevalence of hypertension, a lower mean high-density lipoprotein cholesterol (HDL-C) concentration, a higher prevalence of smoking, a higher mean waist-to-h...

HIV infection, aging and cardiovascular disease: epidemiology and prevention

“…In the D:A:D study, at the time of any cardiovascular event, only 23% were receiving lipid-lowering medication and a further 45% were treated in the following 6 months. 93 Even when lipid-lowering drugs are used, more than 50% do not reach the levels recommended by the ATP-III guidelines in two cohort studies 94,95 and one randomised trial. 96 The management of hypertension and diet are components of the management and prevention of dyslipidaemia and CVD.…”

Effectiveness of lipid-lowering therapy in HIV patients

“…Another important concern is that the effects of lipidlowering treatment in HIV-infected patients appear to be relatively modest, with more than 50% of patients not reaching ATP-III goals in two retrospective cohort studies [20,21 ] and one randomized clinical trial [22]. A recent large observational study [23] showed a lower response to lipid-lowering therapy in HIV-infected than in non-HIV dyslipidemic subjects.…”

Nutrition and the HIV-associated lipodystrophy syndrome

“…This demonstrates an enthusiasm and acceptance of these dietary supplements by HIV-positive adults with hypertriacylglycerolaemia. The effects of n-3 LC-PUFA on lipoprotein concentrations in HIV-positive adults are unclear, with no effect (262) , 11 % raised HDL (266) and 22·4 % raised LDL (258) reported. EPA and DHA have been shown to have anti-inflammatory effects in vitro via their role as PPAR-g ligands (267) and modulation of the NF-kB signalling system (268,269) .…”

“…The TAG-lowering effects of the n-3 LC-PUFA among HIV-positive adults are supported by three smaller prospective studies (262 -264) , although Virgili et al (265) showed no significant effect among nine HIV-positive subjects receiving 1120 mg EPA and 720 mg DHA daily for 6 weeks. A review of 237 hospital charts from HIV-positive adults with hypertriacylglycerolaemia showed that the use of n-3 LC-PUFA supplements was associated with a 32 % reduction in TAG concentrations (266) . Furthermore, at baseline 11 % of subjects used these dietary supplements, whereas at 6 months 25 % of subjects used the supplements (266) .…”

“…A review of 237 hospital charts from HIV-positive adults with hypertriacylglycerolaemia showed that the use of n-3 LC-PUFA supplements was associated with a 32 % reduction in TAG concentrations (266) . Furthermore, at baseline 11 % of subjects used these dietary supplements, whereas at 6 months 25 % of subjects used the supplements (266) . This demonstrates an enthusiasm and acceptance of these dietary supplements by HIV-positive adults with hypertriacylglycerolaemia.…”