Effect of fish oil (n-3 polyunsaturated fatty acids) on plasma lipids, lipoproteins and inflammatory markers in HIV-infected patients treated with antiretroviral therapy: A randomized, double-blind, placebo-controlled study

Abstract

Patients on antiretroviral therapy are reported to have an increased risk of cardiovascular disease. We aimed to investigate the effect of n-3 polyunsaturated fatty acids (n-3 PUFAs) on plasma lipids, lipoproteins and inflammatory markers in HIV-infected patients treated with antiretroviral therapy. We randomized 51 patients in a placebo-controlled, double-blind trial to receive either 2 capsules of Omacor twice daily or 2 capsules of placebo. Compliance was measured by determining levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in neutrophils. Plasma triglycerides were reduced in the n-3 PUFA group by 0.14 mmol/l after 12 weeks of treatment (n=26), while plasma triglycerides increased by 0.36 mmol/l in the control group (n=25). The difference between groups was significant, p=0.03. No significant effect of treatment was found for total cholesterol, high-density lipoprotein (HDL) or low-density lipoprotein (LDL) cholesterol or apolipoproteins. There was a significant increase in leukotriene B5 (LTB5) and LTB5/LTB4 ratio in the n-3 PUFA group compared to the control group. Baseline values for intercellular adhesion molecule-1 (ICAM), vascular cell adhesion molecule-1 (VCAM) and highly sensitive C-reactive protein (hsCRP) were comparable at baseline, and the intervention did not change these parameters significantly. The present study showed that treatment with n-3 PUFA slightly decreased plasma triglycerides and induced anti-inflammatory effects by increasing formation of anti-inflammatory LTB5.

Effectiveness of n-3 fatty acids in the treatment of hypertriglyceridemia in HIV/AIDS patients: a meta-analysis

“…The reduction was commensurate to the initial levels of triglycerides. The higher TG, major reduction is encountered (Peters et al 26 > 400 mg/ dL, Paranandi et al 18 >200 mg/dL and Thusgaard et al 29 < 200 mg/dL) Our study has limitations, due to the reduced number of studies included, different dosages of Omega 3, difference of interventions associated with concomitant use of diets, use of hypolimiants, further to initial TG levels and differences of TARV regimen. Among them, it is possible to single out the absence of non-published studies, the impossibility of evaluating the existence of bias of publication due to the small number of studies included and heterogeneity.…”

“…Other studies that also adopted the same dosage of EPA/DHA 18,26,29 and that had different initial levels of TG, also presented different results. The reduction was commensurate to the initial levels of triglycerides.…”

“…Omacor® -3360 mg 26,29 ; Maxepa® -2700 mg 25 ,1800 mg 27 ; Lovaza® -3360 mg 18 ; Coromega® -2900 mg 28 ; Salmon oil -900 mg 15 ; Fish oil -4000 mg 17 , 900 mg 16 The studies included in this revision are shown in Chart 1. Year variables, classification of Jadad et al 19 , EPA and DHA dosage and initial triglycerides were analyzed to evaluate heterogeneity.…”

“…Various TARV regimens were described, using protease inhibitors (PIs), NRTI (nucleoside analog reverse-transcriptase inhibitors) and NNRTI (non-nucleoside analog reverse-transcriptase inhibitors) in various combinations; and the stable use for a period of ≥ 2 months 27 ; ≥ 3 months 16,18,26,28,29 ; ≥ 6 months 15,17,25 was inclusion criteria.…”

“…The heterogeneity encountered was considered moderate according to Higgins &Thomp-son 22 . Two analysis of the subgroup were conducted, the first excluding the studies that used under 1000 mg EPA/DHA day 15,16 dosages and the second, excluding the studies with initial triglycerides under 200 mg/dL 16,29 ; in both studies, the heterogeneity was 0%.…”