Omega-3 supplement effective to reduce triglycerides

In an oral presentation at the conference, a double blind, randomised trial carried out by French researchers with 122 subjects over 16 weeks showed the efficacy of using Omega-3 polyunsaturated fatty acids to treat hypertriglyceridaemia in patients receiving HAART.

Sixty HIV-positive patients received Maxepa capsules containing 1g fish oil (2 capsules, 3 times a day, 18% EPA, 12% DHA) and 62-patients received placebo (1g paraffin oil capsules), all of whom were receiving HAART and had high triglycerides greater than 2 g/L after four weeks of appropriate dietary advice. Patients were given 8 weeks of treatment or placebo, followed by 8 weeks of open label treatment.

The median change in triglycerides at week 8 was –25.5% in those receiving treatment compared to +1% in those on placebo. At the same point the mean triglycerides were 3.4 +/-1.8 g/L in those on treatment, and 4.8 +/- 3.1 g/L in the placebo group (whose only intervention had been dietary advice). Triglycerides were normalised in 22.4% of those receiving Maxepa, but in only 6.5% of those on placebo.

During the open label period triglyceride reductions were maintained in those who had originally received Maxepa, and decreased by 21.2% in patients who had previously been given placebo.

The researchers report that safety was good with no statistically significant differences being observed in the occurrence of adverse events between the two groups.

Patients with baseline triglycerides >10g/L were not randomised and received open label Maxepa. The mean decrease in triglycerides in this group was –35.6%.

Hypertriglyceridaemia is a common blood lipid change seen in people on antiretroviral therapy and its increasing incidence is thought to be associated with high cardiovascular risk.

The researchers concluded that the study demonstrated the efficacy of Omega-3 supplement to decrease triglycerides in ART-treated HIV-infected patients with baseline elevated triglycerides; and represented a potential option for first line therapy for ART-associated hypertriglyceridaemia because of its efficacy, good tolerance, and absence of drug interactions.

Comment

This study looked at the use of 6 capsules of Maxepa per day (2 capsules 3 times a day), but some doctors recommend 5 capsules twice a day. However, many UK clinics prefer to use Omacor 1g capsules which contain 46% EPA and 38% DHA and require just 2 capsules twice a day. Both are available in the UK.

De Truchis P, Kirstetter M, Perier A et al. Treatment of hypertriglyceridemia in HIV-infected patients under HAART, by (n-3)polyunsaturated fatty acids: a double-blind randomised prospective trial in 122 patients. 12th CROI, 2005. Abstract 39.