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Omega-3 fatty acids may reduce triglycerides and improve inflammation in people with HIV
Liz Highleyman, 2016-11-09 07:20:00
Long-term use of omega-3 fatty acid supplements was associated with
reduced levels of triglycerides and the inflammation biomarker C-reactive
protein (CRP) in HIV-positive people with suppressed viral load, according to
research presented last week at IDWeek 2016 in New Orleans.
As people with HIV live longer thanks to effective antiretroviral
therapy (ART), chronic conditions such as cardiovascular disease and cancer are
a growing concern. Research suggests that chronic inflammation and excessive
immune activation contributes to the increased risk of these non-AIDS
conditions in this population, even when taking effective ART.
Gretchen Volpe of Tufts University School of Medicine
and colleagues conducted a randomized, placebo-controlled trial - the longest
to date - of high-dose omega-3 fatty acids for people with HIV, evaluating
their long-term effects on blood lipid levels, inflammation, and vascular
function. Omega-3 fatty acids -
found in fish oil - are often taken to reduce triglycerides.
The study included 117 participants on stable ART with
elevated triglycerides (fasting level between 150 and 2500 mg/dl or random
level >200 mg/dl). About 80% were men and the mean age was 51 years. The
mean CD4 count was 648 cells/mm3 and 95% had undetectable viral
load. Metabolic factors, smoking and alcohol use, HIV status, and baseline
lipids and vascular function were similar in both groups, About 30% in both
groups used statins, but people who regularly used fish oil were excluded.
Participants were randomly assigned to receive either
4 grams daily of omega-3 fatty acids or placebo for 24 months. They used the Lovaza formulation, which contains a combination of omega-3 acid ethyl esters, primarily
eicosapentaenoic acid and docosahexaenoic acid (465mg and 375mg, respectively,
per 1-gram capsule). The formulation is approved for reducing triglyceride
levels in people with severe hypertriglyceridemia.
All participants were also counselled about switching to a lipid-lowering diet
and maintaining a stable weight.
After 33 patients were lost to follow-up (a similar
number in both arms), the researchers analysed 43 people randomized to the
omega-3 arm and 40 assigned to the placebo arm.
The primary outcomes were changes in
triglycerides, high-density lipoprotein cholesterol (HDL) and the inflammation
marker CRP. The researchers also looked at total cholesterol and low-density
lipoprotein (LDL), as well as indicators of vascular function, including
brachial artery reactivity and arterial stiffness as measured by pulse wave
At 24 months,
median triglyceride levels had decreased significantly more in the omega-3 arm
compared to the placebo arm (-68 vs -22 mg/dl). Triglycerides declined through
12 months in both arm, but then continued declining between months 12 and 24 in
omega-3 arm while reaching a plateau in the placebo arm.
significantly in the omega-3 arm by 24 months, but not in the placebo arm (-0.3
vs +0.6 mg/l). In both arms CRP decreased over the first 12 months, but then
increased between months 12 and 24. CRP stayed below the baseline level in the
omega-3 arm, but rose above it in the placebo arm.
There was no
significant difference in HDL levels between the two treatment groups. There
was also no significant difference in total cholesterol or LDL levels at any
time, however there was a trend towards a greater reduction in total
cholesterol in the omega-3 group over 24 months (-9.2 vs +3.9 mg/dl).
reactivity did not differ significantly between the two groups. There was a
trend towards reduced carotid-femoral arterial stiffness over 24 months in the
omega-3 arm, but the difference did not reach statistical significance (-46 vs
acids were generally safe and well tolerated, and serious adverse events did
not differ between the two treatment groups, Volpe reported. Adherence was found
to be "feasible" over the two-year time frame.
omega-3 fatty acid supplementation appears beneficial for people with HIV and
its efficacy may increase over time, the researchers concluded. Omega-3 fatty
acids "may reduce inflammation, as measured by CRP, even for those whose
CRP is within the normal range at baseline."
success in managing HIV infection, we are now aiming to optimize the duration
and quality of life for people living with HIV/AIDS, for whom interventions
such as omega-3 fatty acids may be of benefit," they wrote in their