Intervention for Hyperlipidemia Associated With Protease Inhibitors

Melroe, N. Holly; Kopaczewski, Jessica; Henry, Keith; Huebsch, Jacquelyn A.

doi:10.1016/s1055-3290(06)60310-5

Cited by 23 publications

(6 citation statements)

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“…There were seven reported cases of premature myocardial infarction in patients on HAART who only exhibited moderately elevated triglycerides (range: 1¢58^4¢16 mmol/ L). 10,11,25 The remaining report was of a patient on AZT, 3TC and nel¢navir with severe hypertriglyceridaemia (25¢8 mmol/ L) but no associated clinical symptoms, 7 like the two cases we report here.…”

Section: Discussionmentioning

confidence: 58%

“…To date, there have been at least 17 individual case reports of HIV-positive patients on HAART with hypertriglyceridaemia. Nine of these cases demonstrated severe hypertriglyceridaemia associated with speci¢c clinical symptoms: pancreatitis (nˆ6); 5^10 cardiac events (nˆ2); 10 lipaemia retinalis (nˆ1) 8 and cutaneous xanthoma (nˆ1). 24 Table 3 summarize s the antiretroviral therapy, the post-therapy triglyceride concentrations and the clinical symptoms associated with each of these cases.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Subsequently, it was reported that antiretroviral drugs, in particular the protease inhibitors, are independently associated with a small but signi¢cant mean rise in the concentration of both triglycerides (1¢1 mmol/ L) and total cholesterol (0¢73 mmol/ L). 3,4 Markedly elevated triglyceride concentrations (410 mmol/ L) have been reported in a small number of patients, and pancreatitis 5^10 and premature myocardial infarction 10,11 were complications in some of these cases. We report two new cases of severe hypertriglyceridaemia that responded to a change in HAART and/or lipidlowering drugs.…”

Section: Introductionmentioning

confidence: 99%

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Severe hypertriglyceridaemia associated with human immunodeficiency virus and highly active antiretroviral therapy

et al. 2002

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We report two cases of severe hypertriglyceridaemia associated with human immunodeficiency virus infection and highly active antiretroviral therapy (HAART). The first patient, a 39-year-old man, developed moderate hypertriglyceridaemia (5.88 mmol/L) and hypercholesterolaemia (7.0 mmol/L) after 8 months of HAART. When his therapy was altered, triglyceride and cholesterol concentrations increased further to 15.9 and 10.9 mmol/L, respectively, after 6 weeks. The second patient, a 31-year-old man, presented with triglyceride and cholesterol concentrations of 16.2 and 5.7 mmol/L, respectively, following an 8-year history of HAART. Therapy was changed, but 1 month later the triglyceride concentration had increased to 39.4 mmol/L and the cholesterol concentration to 12.1 mmol/L. Both patients were managed by a change in HAART and the introduction of a fibric acid derivative. Although neither patient displayed any clinical symptoms associated with hypertriglyceridaemia, it is important to recognize such cases because of the associated risk of pancreatitis and coronary disease.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Severe hypertriglyceridaemia associated with human immunodeficiency virus and highly active antiretroviral therapy

et al. 2002

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“…Überdies wirkt sich eine fettkontrollierte Diät positiv auf die Hypertriglyzeridämie aus [76]. Aber auch, wenn durch eine stoffwechseladaptierte Diät gekoppelt an eine individuelle Bewegungstherapie Körperfett reduziert und metabolische Störungen kontrolliert werden können, ist die beobachtete Lipoatrophie vielleicht nicht reversibel [77].…”

Section: Ernährungsanamneseunclassified

Ernährungsmedizinische Aspekte der HIV-Infektion: Nicht mehr nur Wasting!

Gastell¹,

Ockenga²

2003

Akt Ernähr Med

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“…Pharmacokinetic studies suggest that simvastatin should be avoided and atorvastatin used with caution in persons taking ritonavir and saquinavir because of drug–drug interactions [22]. Fibrates, however, are generally regarded as safe and moderately effective [23–27]. The TG‐reducing effects of fish oil, a natural alternative to drugs, have been demonstrated in an HIV‐positive population [28].…”

Section: Introductionmentioning

confidence: 99%

Use of metabolic drugs and fish oil in HIV‐positive patients with metabolic complications and associations with dyslipidaemia and treatment targets

et al. 2007

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BackgroundHighly active antiretroviral therapy (HAART) with protease inhibitors (PI) is successful in suppressing viral replication, but may lead to a range of metabolic abnormalities associated with cardiovascular disease (CVD). ObjectivesThe first objective of the study was to compare baseline demographic and clinical characteristics between PI users and non-PI users referred to a specialized metabolic clinic during [1999][2000][2001][2002][2003]. The second objective was to assess the associations of prescription drugs and fish oil with dyslipidaemia and to determine whether or not patients achieved treatment targets during 6 months of treatment. MethodsA retrospective analysis was performed using two sets of charts based on standardized forms with entries for personal data, drug treatment and clinical history. Anonymous linkage with the British Columbia HIV/AIDS Drug Treatment Program and the hospital laboratory was performed to gather information about HAART prescriptions and blood work. ResultsIn total, 237 patients were included in the study. There were few differences in any demographic or clinical factors between PI users and non-PI users. Compared with controls not taking lipid-lowering drugs or fish oil (n 5 48), statins appeared to be the only agent that was significantly associated with a reduced total cholesterol concentration ( À 15.6%; P 5 0.009). Fibrate treatment was associated with the largest reduction of triglyceride concentration ( À 37.4%; P 5 0.012), closely followed by fish oil (n 5 18; À 32%; P 5 0.027). Six-month treatment success rates ranged between 17 and 43% of patients for total cholesterol (o5.2 mmol/L) and between 15 and 44% of patients for triglycerides (o2.3 mmol/L). ConclusionsDespite the apparent lowering of blood lipids with drug and fish oil treatments, a majority of patients in these treatment groups (56.5-83.3%) still had elevated concentrations after 6 months. expectancy in HIV-positive men and women [2]. Although HAART regimens are able to suppress viral replication, there is evidence that some antiretroviral drugs are associated with a range of metabolic abnormalities that lead to cardiovascular disease (CVD) [3][4][5][6][7][8][9]. Numerous population-based cohort studies have suggested that some protease inhibitors (PIs) are more strongly associated with dyslipidaemia than others [10,11]. For example, hypertriglyceridaemia appears to be more frequent and more severe with ritonavir than with indinavir. In addition, the use of PIs has also been shown to more frequently result in endothelial dysfunction [12] and coronary artery calcification [13]. CVD may be caused by accelerated atherosclerosis [12,14] resulting from side effects of antiretroviral therapy (ART) such as dyslipidaemia, insulin resistance and lipodystrophy [15]. Compared with the general population of a similar age, HIV-positive patients have a lower prevalence of hypertension, a lower mean high-density lipoprotein cholesterol (HDL-C) concentration, a higher prevalence of smoking, a higher mean waist-to-h...

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Intervention for Hyperlipidemia Associated With Protease Inhibitors

Cited by 23 publications

References 23 publications

Severe hypertriglyceridaemia associated with human immunodeficiency virus and highly active antiretroviral therapy

Severe hypertriglyceridaemia associated with human immunodeficiency virus and highly active antiretroviral therapy

Ernährungsmedizinische Aspekte der HIV-Infektion: Nicht mehr nur Wasting!

Use of metabolic drugs and fish oil in HIV‐positive patients with metabolic complications and associations with dyslipidaemia and treatment targets

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