Increased levels of lipids or fatty substances — triglycerides and cholesterol — in the blood of some people with HIV/AIDS (PHAs) who use highly active antiretoviral therapy (HAART) places them at increased risk for cardiovascular disease.
Aware of the risk posed by the increase in lipid levels, doctors who treat HAART-users have prescribed lipid-lowering drugs commonly called statins, examples of which include the following:
In HIV negative people, these drugs have helped to reduce the risk of heart disease. It is not clear which statin is best for PHAs. The answer to this question may well be different for each PHA and may depend on a number of factors, including which treatment regimen a PHA is taking. This is because statins, like protease inhibitors (Pis) and non-nukes, are processed by enzymes in the liver. Using a statin with a PI and/or non-nuke that is processed by the same liver enzyme(s) can affect the activity of those enzymes, meaning that there is the potential for these drugs to interact. Such an interaction could raise or lower levels of one or both drugs in the blood. This can weaken the activity of anti-HIV drugs, leading to resistance, or it could cause new side effects or enhance pre-existing side effects.
Researchers in London, England, conducted a six-month study in 31 male subjects who were receiving PI-based treatment and who had higher-than-normal levels of cholesterol. Half the subjects received advice about changing their diet (dietary advice).The other half received the same advice along with the lipid-lowering drug Pravachol (pravastatin), 40 mg per day. By the end of the study, cholesterol levels fell in the Pravachol-users by 17% and in those receiving dietary advice alone, by 4%.
Researchers recruited 31 male subjects who were receiving the following PIs as part of their treatment regimen:
All subjects received advice about reducing their intake of cholesterol-rich food. They were also advised to quit smoking and begin a programme of regular exercise. Subjects were randomly assigned to receive dietary advice alone or dietary advice with Pravachol 40 mg per day. The drug was taken at a dose of 20 mg per day for the first two weeks after which the dose was increased to 40 mg per day.
At the start of the study, the basic profile of subjects in each group was as follows:
Dietary advice alone —
Dietary advice and Pravachol —
Five subjects left the study for "personal reasons," four of whom were in the dietary advice group and one in the advice and statin group. On average, cholesterol levels fell by the following proportion in each of the following groups:
This difference between the two groups was almost statistically significant. No significant changes to triglyceride levels occured during the study.
Although statins are supposed to be well-tolerated drugs, they can cause tiredness in some users. More seriously, they can damage muscles, causing muscle pain and weakness. No subjects in this study developed such problems. As well, there were no reports of liver damage due to use of Pravachol.
Dietary advice apparently had a greater impact in those subjects who received this advice without a statin. For instance, the intake of saturated fat (generally fat of animal origin) fell by 38% in the group receiving advice only but rose by 2% in the group receiving Pravachol. Intake of sugar fell by 50% in the group receiving dietary advice only and only by 8% in the advice and Pravachol group.
The changes in lipid levels seen in this six-month study, particularly among Pravachol-users, are not surprising. Perhaps more significant changes may have occurred among these subjects had they adhered to suggested changes in diet and exercise. Readers should note that it may be more difficult to reduce lipid levels in people using HAART than in HIV negative people not taking HAART. Other interventions such as eating fish that is rich in omega-3 fatty acids — cod, haddock, herring, tuna, salmon and sardines — as well as the use of supplements such as L-carnitine and antioxidants need to be tested in HAART-users with high lipid levels in their blood.
Moyle GJ, Lloyd M, Reynolds B, et al. Dietary advice with or without pravastatin for the management of hypercholesterolaemia-associated with protease-inhibitor therapy. AIDS 2001;15:1503-1508.
20010810
CATE12003
Copyright © 2001 - TreatmentUpdate. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Editor, The Canadian AIDS Treatment Information Exchange, 555 Richmond St. West, Suite 505, Box 1104, Toronto, ON, M5V 3B1 • Phone: 416-203-7122 • Toll Free: 1-800-263-1638 • Fax: 416-203-8284 http://www.catie.ca.
AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, Elton John AIDS Foundation, iMetrikus, Inc., the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 2001. This material is designed to support, not replace, the relationship that exists between you and your doctor.
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
