High triglyceride levels are common among HIV-infected patients receiving potent antiretroviral therapy (ART) and may increase their risk for coronary artery disease. Fish oil and fibrates have each been shown to reduce triglyceride levels in HIV-infected patients, but few comparative data are available.
To address this gap, ACTG investigators conducted a randomized trial among 100 HIV-infected patients receiving ART who, despite dietary interventions, had fasting serum triglyceride levels ≥400 mg/dL and LDL cholesterol levels ≤160 mg/dL. Patients were randomized to receive fish oil (3 g twice daily) or fenofibrate (160 mg once daily) for 8 weeks, at which point they were evaluated for response. Those who did not achieve triglyceride levels ≤200 mg/dL were given both fish oil and fenofibrate for an additional 8 weeks.
At screening, median triglyceride levels were 665 mg/dL in the fish-oil group and 695 mg/dL in the fenofibrate group. After 8 weeks, triglyceride levels fell by 46% in the fish-oil group and by 58% in the fenofibrate group. Patients who went on to receive combination therapy had a median 66% decrease in triglyceride levels from baseline to 18 weeks. Use of fish oil did not significantly affect immunologic parameters or the trough concentrations of lopinavir. Both treatments were generally well tolerated.
Comment
Each gram of fish oil used in this study contained 500 mg of EPA (eicosapentaenoic acid), 310 mg of DHA (docosahexaenoic acid), 190 mg of other omega-3 fatty acids, and 20 IU of D-α-tocopherol; results with other doses or mixtures of fish oil might differ from those seen here. Although only 23% of patients who received combination therapy achieved triglyceride levels ≤200 mg/dL, the magnitude of response and the overall safety profile provide reassurance that fish oil and fibrates, used either separately or together, are reasonable options for managing elevated triglyceride levels in HIV-infected patients.
http://www.medscape.com/viewarticle/574464?src=mp&spon=17&uac=88630HN