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Dietary intervention prevented dyslipidemia associated with HAART

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Patients with HIV who followed a dietary intervention for 1 year had less evidence of highly active antiretroviral therapy-associated dyslipidemia than patients with HIV who did not follow a diet, according to results of a randomized trial.

The Effect of Nutritional Intervention on the Lipid Profile of HIV-Positive Patients who Start HAART trial included 83 patients with HIV living in southern Brazil who were naïve of previous treatment. The HIV-infected patients were randomly assigned to highly active antiretroviral therapy (HAART) with (diet group, n=43) or without (control group, n=40) dietary intervention from March 2004 to April 2006. The diet group received quarterly nutritional guidance focused on dyslipidemia and all patients were followed up after 1 year of treatment. The control group also received baseline nutritional guidance, but researchers did not provide guided nutritional follow-up. The most commonly prescribed HAART regimen was efavirenz (80% of diet group; 85% of control group) or zidovudine and lamivudine.

After 1 year, fat intake decreased from 31% to 21% of calories in the diet group. No change was observed in the control group. Plasma cholesterol increased from 151 mg/dL to 190 mg/dL and LDL increased from 85 mg/dL to 160 mg/dL in the control group, but levels were unchanged in the diet group. Plasma triglycerides decreased in the diet group, from 135 mg/dL to 101 mg/dL, but increased in the control group, from 134 mg/dL to 160 mg/dL.

Twenty-one percent of patients in the diet group developed alterations in their lipid profile that were compatible with dyslipidemia compared with 68% of the control group. At 1 year, only 7% of patients in the diet group were diagnosed with hypercholesterolemia compared with 39% of controls.

The researchers said the nutritional intervention used in this study focused on the quality of lipids consumed, to decrease saturated and trans fats and daily cholesterol intake and to increase monounsaturated and polyunsaturated fatty acids and fibers.

“Our study demonstrates that this nutritional intervention controlled the changes in lipid profile in the HIV-1–infected individuals who started HAART,” the researchers wrote.

In an accompanying editorial, James H. Stein, MD, of the preventive cardiology program at the University of Wisconsin School of Medicine and Public Health, wrote: “Nutritional interventions can prevent adverse changes in the lipid profile of HIV-infected patients who start highly active antiretroviral therapy. These findings emphasize the importance of nutritional interventions at the time of highly active antiretroviral therapy initiation to improve CVD risk factors.”

For more information:

• Lazzaretti RK. J Am Coll Cardiol. 2012;59:979-988.
• Stein JH. J Am Coll Cardiol. 2012;59:989-990.

Disclosure: The researchers report no relevant financial disclosures. Dr. Stein is on the Data and Safety Monitoring committees for Abbott, Lilly and Takeda.

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