Selected highlights from the 4th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV
High levels of blood fats such as triglycerides (TG) increase the risk for cardiovascular disease as well as diabetes. Unfortunately, in some HAART users, TG levels soar over time. Although changes to diet, an exercise program and lipid-lowering medication can lower TG levels, supplements of the B vitamin niacin can also do the same. In HIV negative people, high doses of niacin (between one and three grams daily) have been used to lower TG levels. Because of concern that high-dose niacin may pose a risk to the liver and increase the chance of developing type 2 diabetes, researchers at the University of Hawaii tested this supplement in a clinical trial of eight HIV positive subjects.
All subjects had higher-than-normal TG levels, averaging nearly 500 mg/dL. They made changes to their diet and began an exercise program. If after eight weeks their TG levels did not improve, doctors gave them extended-release niacin (Niaspan) 500 mg/day. This dose was increased each month until subjects were taking 1,500 mg/day. The reason for gradually increasing the dose is that high doses of niacin can sometimes cause skin flushing, redness and itching.
After six months of niacin therapy, all subjects were able to take the 1,500 mg/day dose. No significant changes in blood sugar or liver enzyme levels were detected. TG levels fell significantly, on average by over 300 mg/dL. One subject developed low phosphorus levels and had to receive a supplement of this metal. Niaspan was safe, effective and well tolerated in this small study.
People should not be discouraged that changes to diet and exercise did not improve TG levels because in this study these interventions were only carried out for two months.
REFERENCE
Souza S, Chow D, Walsh E, et al. A 36-week safety and tolerability study of extended-release niacin for the treatment of hypertriglyceridemia in subjects with HIV. Abstract 49.
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