13th Conference On Retrovirus and Opportunistic Infections

Metabolics and HIV?

An Adult AIDS Clinical Trials Group (AACTG) study found that high triglyceride levels were significantly lowered when taking fish oil or fenofibrate alone, and even more of a decrease was seen when both were taken in combination.

Following an American Heart Association Scientific Statement on fish oil and triglycerides, some researchers decided to look at using the supplement in HIV patients with high triglycerides. Fish oil contains omega-3 fatty acids. Tricor is one of the brand names for fenofibrate, a drug used to lower levels of cholesterol and triglyceride. The cost of this medication starts around $60 a month, but is available generically for about $50 monthly.

The study, ACTG A5186, randomized 100 people with triglyceride levels of 400 and normal LDL (the good cholesterol) to 3 grams of fish oil twice a day, or 160 mg of fenofibrate once a day. At 8 weeks, 4/47 (8%) who took fish oil and 8/48 (17%) on fenofibrate had triglycerides below 200 mg/dL. Seventy-five people who were unable to get their triglycerides below 400 then combined the fish oil and fenofibrate, and, using a strict intent-to-treat analysis, 17 (23%) had triglycerides levels below 200 at 18 weeks from the start of the study.

The role of genetics

There were several studies presented at this year’s CROI which looked at how genetics may play a role in body fat changes or blood fat levels in those on HIV treatment, which may someday allow doctors to customize an individual’s treatment to fit his or her genetic profile. While these preliminary findings hold some promise, they require further study, so don’t expect to see them in your doctor’s office anytime soon.

HIV medicines and your heart

Increased protease inhibitor (PI) exposure was associated with an increased risk of myocardial infarction (MI), according to a new analysis of the D:A:D study (Data Collection on Adverse Events of Anti-HIV Drugs). This 11-cohort study of over 23,437 individuals in Europe, the U.S., and Australia found that for every additional year of PI therapy there was a 16% increase in risk for MI.

Hardening of the arteries

A 3-year follow-up study of ACTG 5078, an analysis which looked at 134 HIV-infected and uninfected adults, found that when matching for known coronary heart disease (CHD) risk factors, neither HIV infection nor PI exposure significantly affected the rate of progression of carotid intima-media thickness (IMT), a marker of early atherosclerosis (cholesterol build-up, or hardening of the arteries), suggesting that “classic” CHD factors play a more significant role than ART in the increased risk of cardiovascular events in HIV-infected individuals. (For an explanation—albeit technical—of hardening of the arteries, visit www.americanheart.org/presenter.jhtml?identifier=1243.)