Bezafibrate for the treatment of hypertriglyceridemia in HIV1-infected patients on highly active antiretroviral therapy

Abstract

The use of highly active antiretroviral therapy (HAART) in HIV-infected patients has been associated with the development of risk factors for cardiovascular diseases (CD) including dyslipidemia and insulin resistance, hypertriglyceridemia being the most frequent metabolic disturbance in these patients. Fibrates are indicated when hypertriglyceridemia is accentuated and persists for over six months. We evaluated the efficacy and safety of bezafibrate for the treatment of hypertriglyceridemia in HIV-infected individuals on HAART. All patients received 400mg/day of bezafibrate and were evaluated three times: Mo (pre-treatment), M1 (one month after treatment), and M2 (six months after treatment). Fifteen adult individuals, eight males and seven females with mean age = 41.2 +/- 7.97 years and triglyceride serum levels > 400mg/dL were included in the study. Smoking, alcohol ingestion and sedentarism rates were 50%, 6.66% and 60%, respectively. Family history of CD, hypertension and diabetes mellitus was reported in 33.3%, 40% and 46.7% of the cases, respectively, while dyslipidemia was reported by only 13.3%. More than half of the patients were using a protease inhibitor plus a nucleotide analog transcriptase inhibitor. Eutrophy and tendency toward overweight were observed at all three study time points. There were significant reductions in triglyceride serum levels from Mo to M1 and from Mo to M2. No significant changes were observed in the serum levels of creatine phosphokinase, hepatic enzymes, CD4+, CD8+ and viral load. Therefore, bezafibrate seems to be safe and effective for the reduction of hypertriglyceridemia in HIV-infected patients on HAART.

Dislipidemia em pacientes HIV/AIDS em uso de anti-retrovirais num hospital universitário, Rio de Janeiro, Brasil

“…A alta prevalência de dislipidemia em portadores de HIV é um fato alarmante, pois esse distúrbio está associado ao aumento de doenças cardiovasculares (1,3,6,18,31) .…”

“…A média de idade dos pacientes envolvidos nesta pesquisa é representativa dos casos de AIDS notificados no Brasil (23) e semelhante à observada em outros estudos sobre prevalência de dislipidemia (7,12,18,27) . Não encontramos correlação entre idade e ocorrência de alterações lipídicas, ao contrário do observado por outros autores (2,7) .…”

South Asian Consensus Guidelines for the rational management of diabetes in human immunodeficiency virus/acquired immunodeficiency syndrome

“…Bezafibrate also seems to be safe and effective for the reduction of hypertriglyceridemia in HIV-infected patients on HAART. [26] Though little is known about the comparative effectiveness of statins among HIV-infected patients, it appears that atorvastatin and rosuvastatin are preferable to pravastatin for the treatment of HIV-infected patients with dyslipidemia. This may be due to greater declines in total cholesterol, low density lipoprotein-cholesterol (LDL-C), and non–high density lipoprotein-cholesterol (non–HDL-C), with similar lower toxicity rates.…”

HIV and cardiovascular risk

“…More specifically, statins and newer agents (eg ezetimibe) that selectively inhibit the absorption of cholesterol in the small bowel are the most effective agents for treating hypercholesterolaemia, while fibric acid derivatives (fibrates) are more effective for treating hypertriglyceridaemia and raising HDL levels. 14 The National Cholesterol Education Programme (NCEP) Adult Treatment Panel III guidelines provide directions for managing dyslipidaemia, with targets adjusted according to risk. 15 Patients taking statins should be monitored closely as the potential for drug interactions, particularly between PIs and statins, may increase the risk of toxicity, in particular rhabdomyolysis.…”