Diet can help reduce lipid levels in people with HAART-related dyslipemia
Graham McKerrow, HIV i-Base
A dietary intervention seems to be moderately effective for reducing lipid levels in HIV-infected patients with highly active antiretroviral therapy (HAART)-related dyslipemia and provides the benefit of avoiding the potential toxicity of lipid-lowering drugs, according to researchers in Madrid.
Changes in cholesterol and triglyceride levels after prescribing a lipid-lowering diet were assessed in 230 HIV-infected patients with dyslipemia associated with antiretroviral therapy. The results were reported in a letter published in the 18 October issue of the journal AIDS
Researchers at the Instituto de Salud Carlos III and the Universidad Autónoma de Madrid report that lipid levels decreased significantly in subjects having good diet compliance. The reduction in triglyceride levels was greater than in cholesterol levels. Patients on protease inhibitor-containing regimens experienced a significantly greater decline in lipid levels compared with the rest.
Dyslipemia associated with HAART is a prevalent condition in patients living with HIV. Both hypercholesterolemia and hypertriglyceridemia constitute well-recognised cardiovascular risk factors.
“This fact raises major concerns,” they write, “because HIV infection has become a chronic disease in most infected patients. Episodes of serious premature vascular events (mainly myocardial infarction) have begun to be reported in individuals on HAART.”
Pancreatitis also represents a relevant complication of severe hypertriglyceridemia. Therapeutic interventions in HIV-infected patients with lipid disorders include low-fat diet, exercise, smoking cessation, drug therapy (fibrates and statins), and a modification of antiretroviral therapy.
No specific recommendations exist for the management of dyslipemia in people on HAART and interventions are based on guidelines drawn up for the general population, report the researchers.
“The use of lipid-lowering drugs is of concern given their toxicity, intolerance, and potential interactions with antiretroviral agents,” they write. “Non-pharmacological interventions (diet and exercise) should always be the first line of intervention.
“In HIV-uninfected individuals, dietary advice may achieve an 11 and 22% decline in cholesterol and triglyceride levels, respectively. In HIV-infected individuals, these figures range from 4 to 17% and from 21 to 26%, respectively.”
They assessed prospectively the efficacy of a low-fat diet on cholesterol and triglyceride level reduction in a well-characterised group of 230 HIV-infected patients on HAART with dyslipemia. Subjects with hypercholesterolemia (cholesterol >= 200 mg/dl) or hypertriglyceridemia (triglycerides >= 200 mg/dl) were prescribed a lipid-lowering diet and followed for three months (n = 161) and six months (n = 70). None received drugs for dyslipemia, and antiretroviral regimens remained unchanged during the study period. Fasting lipid levels, lipid variation (percentage), and nutritional status (weight and serum albumin) were recorded longitudinally. Mean values were compared according to diet adherence and type of antiretroviral regimens.
Lipodystrophy body shape changes were present in 66% of individuals. Within the study population, 40% had only hypercholesterolemia, 7% had only hypertriglyceridemia, and 53% had both.
Overall, 58 (36%) and 32 (45%) of patients reported a good compliance with the prescribed diet at three and six months, respectively. The mean values of lipid levels significantly decreased compared with baseline in those subjects. The reduction at three and six months was of 11% (n = 58) and 10% (n = 28) for cholesterol, and of 12% (n = 31) and 23% (n = 20) for triglyceride levels, respectively. In subjects who were non-adherent to diet, cholesterol values decreased in 1% (n = 92) and 2% (n = 35), and triglyceride values decreased in 1% (n = 66) and 9% (n = 21), respectively, at three and six months.
With respect to antiretroviral treatment, the decrease in lipid levels in patients adherent to diet was greater in those under PI-based combinations, being statistically significant for both cholesterol and triglyceride values at six months. In subjects on PI, cholesterol and triglyceride reductions were 13 and 15% at three months (n = 48), and 22 and 49% at six months (n = 17), respectively. In contrast, in patients under PI-sparing regimens, these figures were 8 and 7% at three months (n = 41), and 3 and 8% at six months (n = 31), respectively.
In multivariate analysis, physical exercise was significantly associated with triglyceride level variation, and good adherence to dietary advice was significantly associated with cholesterol level variation at three months. At six months, the variables significantly associated with a decline in lipids were good diet compliance with triglyceride level variation, and good diet compliance along with PI-based treatment with cholesterol level variation.
The researchers conclude: “A dietary intervention seems to be moderately effective for reducing lipid levels in HIV-infected patients with HAART-related dyslipemia. It provides the benefit of avoiding the potential toxicity of lipid-lowering drugs. Good diet compliance was followed by less than half of the subjects.
“In individuals with mild or moderate dyslipemia, a low-fat diet prescription could be sufficient to treat their metabolic abnormality, particularly if no other cardiovascular risk factors are present. Whereas good diet compliance may result in a significant reduction in triglyceride levels, without compromising the nutritional status, the benefit is less apparent on cholesterol levels. Reductions in cholesterol levels are more apparent in subjects under PI-based combinations.”
Ana Barrios; Francisco Blanco; Teresa García-Benayas et al. Effect of dietary intervention on highly active antiretroviral therapy-related dyslipemia. (Research letters) AIDS 16(15): 2079-2081; Oct 2002