HIV-positive patients with elevated blood triglyceride levels may benefit from a combination of fish oil and fenofibrate if they have failed to respond to either treatment alone, according to the results of the AIDS Clinical Trials Group (ACTG) A5186 study. The study’s findings were presented on Wednesday at the Thirteenth Conference on Retroviruses and Opportunistic Infections in Denver.
In addition to exercise and a healthy diet, fish oils, which are rich in omega-3 fatty acids, and the drug fenofibrate are both effective at reducing the levels of triglycerides, a type of fat, in the blood. Since patients receiving treatment for HIV are at an elevated risk of elevated triglyceride levels, doctors are keen to find out the most effective ways to reduce these levels in HIV-positive patients.
A5186 is a study examining the blood fat levels in a group of 100 patients with triglyceride levels above 400mg/dl but low levels of low-density lipoprotein (LDL or ‘bad’) cholesterol. Originally randomised to receive either 3g fish oil or 160mg fenofibrate, 75 (90%) of the patients still in the study after eight weeks had failed to reduce triglyceride levels to below 200mg/dl.
These patients were treated for a further twelve weeks with a combination of the two agents, resulting in a median triglyceride reduction of 65%.
Although 77% of the patients completing the combination of fish oil and fenofibrate did not achieve final values below 200mg/dl, John Gerber, presenting, pointed out that the study demonstrated that the drug combination caused an overall reduction in triglycerides that was significantly greater than 10%. This was the level considered to be clinically meaningful by the study investigators.
Only three patients stopped the treatment combination because of side-effects, while the fish oil treatment did not affect CD4 cell levels or the functioning of the immune system against disease-causing organisms.
The investigators also examined the effects of fish oil on blood levels of lopinavir, the most commonly prescribed protease inhibitor taken by the patients, finding no difference before and after fish oil administration.
Although the combination of drugs caused a small increase in LDL cholesterol levels, Dr Gerber was unable to comment on the effect this would have on the risk of cardiovascular disease.
Future studies of this drug combination are planned, including higher doses of fish oil, to find better ways to treat patients with blood fat levels that do not respond to single drug treatment.
Gerber J et al. The safety and efficacy of fish oil in combination with fenfibrate in subjects on ART with hypertriglyceridemia who had an incomplete response to either agent alone: results of A5186. Thirteenth Conference on Retroviruses and Opportunistic Infections, Denver, abstract 146, 2006.