Diet modification can successfully reduce cholesterol levels in HAART-treated HIV-positive patients, according to a small study published in the June 13th edition of the journal AIDS.
Rather than advising patients to eat a low-fat diet, investigators in Australia counselled patients to modify their fat intake and consume less saturated fat and more polyunsaturated and monounsaturated fats. Patients were also advised to maintain a high fibre intake consistent with nutritional guidelines. Such recommendations are in-line with general advice provided to patients with elevated blood cholesterol (hypercholesterolemia).
Elevated blood fat levels have been associated with anti-HIV drugs, particularly protease inhibitors, as part of the lipodystrophy syndrome of blood and body fat abnormalities. Chronic hypercholesterolemia is a risk factor for cardiovascular disease. Early published studies have looked at the effect of reducing total fat consumption on cholesterol levels. These have shown promising short-term results, but there are questions about how sustainable patients find long-term total fat reduction.
The study involved sixteen HIV-positive men with hypercholesterolemia, fourteen of whom were taking a protease inhibitor-based HAART regimen. The average age of the men was 45 years, mean viral load was 158 copies/mL and average CD4 cell count was 722 cells/mm3.
Increased cholesterol levels (average 7.47mmol/L, normal range less than 5.2mmol/L) led to the men being referred to dietary counseling. Dietary intake was assessed using diet histories and cholesterol levels were measured during routine HIV care.
A minimum of three counselling sessions was provided to each patient, over a period of three to eighteen months. Although the men did not significantly reduce their total fat intake (36% of total calories at baseline to 33% at the end of the study, normal range 30-35%, p=0.355), or reduce their daily calorie intake (2,300 – 2,400 calories), consumption of low fat dairy produce and lean meat helped the men achieve reduce their total calorific intake from saturated fat from 40% to 28% (normal range below 20%, p=0.000).
Use of polyunsaturated fat also increased from 5% of fat derived calories to 13%(p=0.001). Fifteen patients also increased their fish consumption, although four patients were unable to eat the two recommended portions a week. Monounsaturated fat intake did not increase significantly as the men were already using olive oil in their diet at baseline.
Fibre intake increased from 22g a day to 29g a day (p=0.015), just below the recommended 30g a day.
None of the men in the study modified their HAART regimen.
These dietary changes achieved an average fall in serum cholesterol from 7.47mmol/L at baseline to 6.48mmol/L (p=0.012) at the end of the study, however this was still well above the recommended level of less than 5.2mmol/L.
The investigators conclude, “we have demonstrated the effectiveness of a modified-fat diet in reducing total serum cholesterol in HIV-associated hypercholesterolemia…showing that a modified rather than low-fat diet enhances compliance while reducing cardiovascular risk.” They recommend that “future research investigating the effectiveness of dietary counselling in antiretroviral-associated lipid abnormalities should focus on using a modified-fat rather than low-fat dietary strategy.
Further information on this website
Cholesterol - factsheet
Nutrition - booklet in the information for HIV-positive people series
High levels of HDL cholesterol associated with longer undetectable viral load in HAART patients - news story, May 2003
Lipodystrophy - comprehensive menu of resources
Batterham MJ et al. Modifying dietary fat intake can reduce serum cholesterol in HIV-associated hypercholesterolemia AIDS 17: 1414 – 1416, 2003.