Changing diet reduces risk of dyslipidemia (abnormal blood fats) in people with HIV starting antiretroviral treatment

Switching to a diet that concentrates on fruits, vegetables, nuts and whole grains was found in a recent study to very significantly reduce the risk of people with HIV developing dyslipidemia when they started antiretroviral treatment. Dyslipidemia is an abnormal amount of fats (such as cholesterol) in the blood. It is generally associated with an increase in risk of cardiovascular disease. Dyslipidemia is one of the side effects frequently found with HIV drugs (protease-inhibitors and nonnucleoside-reverse-transcriptase inhibitors).

The study followed two groups of HIV+ people who were beginning antiretroviral therapy: one group switched to the high-fiber, low-fat diet, and the other group did not. After one year, 68% of the group that did not change its diet had developed dyslipidemia, while only 21% of the group that changed its diet had.

The study was reported in the Journal of the American College of Cardiology, and was accompanied by an editorial that commented:

“it is likely that patients living with HIV infection who do not eat too much (ie, calorie restriction) and who eat fruits, vegetables, nuts, and whole grains (ie, high-fiber, low-cholesterol, and low-fat foods that keep the ‘bowels soft’) will benefit by avoiding illness and improving quality of life […]For patients living with HIV infection, avoiding dyslipidemia also avoids, or at least delays, use of lipid-lowering medications [such as statins], which are expensive and are complicated to use in patients on HAART.”

Quite a lot of advantages!

References:

1. Lazzarretti RK, Kuhmmer R, Sprinz E, et al. Dietary intervention prevents dyslipidemia associated with highly active antiretroviral therapy in human immunodeficiency virus type 1-infected individuals. J Am Coll Cardiol 2012; 59:979-988.
2. Stein JH. Nutritional intervention to prevent dyslipidemia in patients starting antiretroviral therapy for human immunodeficiency virus. J Am Coll Cardiol 2012; 59:989-990.

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The Lowdown on Lipodystrophy – Nelson Vergel on “HIV Lipodystrophy: Where Are We After 10 Years?”

We’d like to recommend this article, by long-time AIDS treatment activist Nelson Vergel, which appears in the July-Dec. 2007 issue of GMHC’s Treatment News

It’s available online at

http://www.gmhc.org/health/treatment/ti/ti21_3_4.html#3

Lipodystrophy has been one of the most discussed side effects of HIV medications in the past ten years, and, as this article points out, its potentially devastating psychological effects have added urgency to the search for scientific understanding about the condition, and treatment options to address it.

This excellent summary divides the discussion into three parts:

–lipoatrophy (fat loss in the face, buttocks, arms and legs)

–lipohypertrophy (fat accumulation in specific areas of the body such as the neck, belly, upper torso, and breasts)

–lipid abnormalities (high LDL [“bad”] cholesterol and triglycerides, low HDL [“good”] cholesterol)

Nelson outlines how Zerit and AZT were especially implicated in lipoatrophy; he also sorts through the ongoing uncertainties about the origins of lipohypertrophy and lipid abnormalities in people with HIV on HAART.

This article is also very useful in reviewing the treatment options for these three conditions, including facial wasting reconstruction therapies like Sculptra (formerly Newfill) for lipoatrophy; prescription drugs for lipohypertrophy (testosterone or Metformin*); nutritional supplements like fish oil and Niacin for lipid abnormalities (these are often most successful when used along with diet and exercise programs, and can enhance the effectiveness of prescription statins).

Nelson Vergel continues to do a great service in making this kind of treatment information available to PWHIV. For more info, you can also visit the website http://www.facialwasting.org, or subscribe to the pozhealth internet HIV health discussion group by sending a blank email to pozhealth-subscribe@yahoogroups.com.

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*See additional posts on this Blog for a recommendation about supplementing with B vitamins when taking Metformin.

Are HIV+ patients resistant to statin therapy?

This was a post on the yahoo group pozhealth from Nelson Vergel. As the piece suggests, statin therapy for people with HIV can be a more complex treatment choice than it is for the HIV negative.

 

We suggest that readers also keep in mind the information on Niacin + statin combination therapy, as presented recently in this Blog (see the “Niacin” category).

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Lipids Health Dis. 2007 Oct 24;6(1):27 [Epub ahead of print]

Are HIV+ patients resistant to statin therapy?

Johns KW, Bennett MT, Bondy GP.

ABSTRACT: BACKGROUND: Patients with HIV are subject to development of HIV metabolic syndrome characterized by dyslipidemia, lipodystrophy and insulin resistance secondary to highly active antiretroviral therapy (HAART). Rosuvastatin is a highly potent HMG-CoA reductase inhibitor. Rosuvastatin is effective at lowering LDL and poses a low risk for drug-drug interaction as it does not share the same metabolic pathway as HAART drugs. This study sought to determine the efficacy of rosuvastatin on lipid parameters in HIV positive patients with HIV metabolic syndrome. RESULTS: Mean TC decreased from 6.54 to 4.89 mmol/L (25.0% reduction, p<0.001). Mean LDL-C decreased from 3.39 to 2.24 mmol/L (30.8% reduction, p<0.001). Mean HDL rose from 1.04 to 1.06 mmol/L (2.0% increase, p=ns). Mean triglycerides decreased from 5.26 to 3.68 mmol/L (30.1% reduction, p<0.001). Secondary analysis examining the effectiveness of rosuvastatin monotherapy (n=70) vs. rosuvastatin plus fenofibrate (n=43) showed an improvement of 21.3% in TG and a decrease of 4.1% in HDL-C in the monotherapy group. The rosuvastatin plus fenofibrate showed a greater drop in triglycerides (45.3%, p<0.001) and an increase in HDL of 7.6% (p=0.08). CONCLUSIONS: This study found that rosuvastatin is effective at improving potentially atherogenic lipid parameters in HIV-positive patients. The lipid changes we observed were of a smaller magnitude compared to non-HIV subjects. Our results are further supported by a small, pilot trial examining rosuvastatin effectiveness in HIV who reported similar median changes from baseline of -21.7% (TC), -22.4% (LDL-C), -30.1% (TG) with the exception of a 28.5% median increase in HDL. In light of the results revealed by this pilot study, clinicians may want to consider a possible resistance to statin therapy when treating patients with HIV metabolic syndrome.