Dieta, dislipidemia, HIV

Parabéns para Rose, Regina e Jorge Pinto Ribeiro
Diet improves lipids in HAART-treated patients
MARCH 6, 2012 Michael O'Riordanare

Porto Alegre, Brazil - A dietary intervention introduced before human immunodeficiency virusIV)-infected patients begin highly active antiretroviral therapy (HAART) prevents dyslipidemia that is typically associated with treatment, research published in the March 13, 2012 issue of the Journal of the American College of Cardiology shows [1]. The nutritional intervention controlled the changes in the lipid profile of HIV-1-infected patients and allowed total-cholesterol, LDL-cholesterol, and triglyceride levels, as well as body-mass index, to remain stable over a 12-month follow-up period.

Led by Dr Jorge Ribeiro (Hospital de Clinicas de Porto Alegre, Brazil), the dietary intervention, which was based on the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III guidelines, focused on the quality of lipids consumed, with the intention of reducing saturated and trans fats, increasing monounsaturated and polyunsaturated fats and fibers, and decreasing total cholesterol intake.

The initiation of HAART for HIV is associated with dyslipidemia, with abnormal changes in the lipid profile caused by protease-inhibitor regimens and nonnucleoside-reverse-transcriptase inhibitors. Clinical guidelines recommend dietary changes to reduce the risk of developing dyslipidemia, but no studies had previously tested a nutritional intervention.

Among 83 patients in this study, all of whom were naive to HAART prior to starting treatment, those randomized to the dietary intervention did not experience any increases in total and LDL cholesterol. In contrast, patients in the control arm had a 39-mg/dL increase in total cholesterol and a 21-mg/dL increase in LDL cholesterol. Plasma triglycerides decreased from 135 mg/dL to 101 mg/dL in those randomized to the NCEP diet but increased in the control arm. At one year, 21% of patients in the diet arm had dyslipidemia compared with 68% of patients in the control arm.

In an editorial accompanying the study [2], Dr James Stein (University of Wisconsin School of Medicine and Public Health, Madison) said the 15% difference in total-cholesterol levels between the study arms would be expected to translate into a long-term reduction in the risk of cardiovascular disease of 25% to 30%.

"Thus, like the medieval Jewish philosopher and physician Maimonides suggested, it is likely that patients living with HIV infection who do not eat too much (ie, calorie restriction) and who eat fruits, vegetables, nuts, and whole grains (ie, high-fiber, low-cholesterol, and low-fat foods that keep the 'bowels soft') will benefit by avoiding illness and improving quality of life," writes Stein. "For patients living with HIV infection, avoiding dyslipidemia also avoids, or at least delays, use of lipid-lowering medications, which are expensive and are complicated to use in patients on HAART."/.../