Combination of niacin and fenofibrate with lifestyle changes improves dyslipidemia and hypoadiponectinemia in HIV patients on antiretroviral therapy: results of "heart positive," a randomized, controlled trial.

Abstract

CONTEXT:

HIV patients on antiretroviral therapy (ART) have a unique dyslipidemia [elevated triglycerides and non-high-density lipoprotein-cholesterol (HDL-C), low HDL-C] with insulin resistance (characterized by hypoadiponectinemia).

OBJECTIVE:

The aim was to test a targeted, comprehensive, additive approach to treating the dyslipidemia.

DESIGN AND SETTING:

We conducted a randomized, double-blind, placebo-controlled, 24-wk trial of lifestyle modification, fenofibrate, and niacin in multiethnic HIV clinics at an academic center.

PARTICIPANTS:

Hypertriglyceridemic adult patients were stratified on three combinations of ART classes. Subjects retained at the first measurement (2 wk) after entry were included in the analysis (n = 191).

INTERVENTIONS:

Subjects were randomized into five treatment groups: usual care (group 1); low-saturated-fat diet and exercise (D/E; group 2); D/E + fenofibrate (group 3); D/E + niacin (group 4); or D/E + fenofibrate + niacin (group 5).

MAIN OUTCOME MEASURES:

We measured changes in fasting triglycerides, HDL-C, and non-HDL-C (primary), and in insulin sensitivity, glycemia, adiponectin, C-reactive protein, energy expenditure, and body composition (secondary). Data were analyzed as a factorial set of treatment combinations using a mixed repeated measures model, last observation carried forward, and complete case approaches (groups 2-5), and as an unstructured set of treatments (groups 1-5).

RESULTS:

Fenofibrate improved triglycerides (P = 0.002), total cholesterol (P = 0.02), and non-HDL-C (P = 0.003), whereas niacin improved HDL-C (P = 0.03), and both drugs decreased the total cholesterol-to-HDL-C ratio (P = 0.005-0.01). The combination of D/E, fenofibrate, and niacin provided maximal benefit, markedly reducing triglycerides (-52% compared to usual care; P = 0.003), increasing HDL-C (+12%; P < 0.001), and decreasing non-HDL-C (-18.5%; P = 0.003) and total cholesterol-to-HDL-C ratio (-24.5%; P < 0.001). Niacin doubled adiponectin levels.

CONCLUSIONS:

A combination of fenofibrate and niacin with low-saturated-fat D/E is effective and safe in increasing HDL-C, decreasing non-HDL-C and hypertriglyceridemia, and ameliorating hypoadiponectinemia in patients with HIV/ART-associated dyslipidemia.

• Authors: Ashok Balasubramanyam, Ivonne Coraza, E O'Brian Smith, Lynne W Scott, Payal Patel, Dinakar Iyer, Addison A Taylor, Thomas P Giordano, Rajagopal V Sekhar, Pamela Clark, Edith Cuevas-Sanchez, Swarna Kamble, Christie M Ballantyne, Henry J Pownall
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 96 Issue 7 Pg. 2236-47 (Jul 2011) ISSN: 1945-7197 [Electronic] United States
• PMID: 21565796 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural)

Chemical References

• Adiponectin
• Anti-Retroviral Agents
• Hypolipidemic Agents
• Triglycerides
• Niacin
• Fenofibrate

Topics

• Adiponectin (blood)
• Adult
• Aged
• Anti-Retroviral Agents (therapeutic use)
• Double-Blind Method
• Dyslipidemias (blood, complications, drug therapy)
• Exercise
• Female
• Fenofibrate (therapeutic use)
• HIV Seropositivity (blood, complications, drug therapy)
• Humans
• Hypolipidemic Agents
• Life Style
• Male
• Middle Aged
• Niacin (therapeutic use)
• Risk Reduction Behavior
• Treatment Outcome
• Triglycerides (blood)