Abstract
Hypertriglyceridemia is common in HIV-infected patients. Polyunsaturated fatty acids reduce fasting serum triglyceride (TG) levels in HIV-infected patients. It is not known whether docosahexanoic acid (DHA) supplementation can reduce hypertriglyceridemia and modify fat distribution in HIV-infected patients. We conducted a randomized, double-blind, placebo-controlled trial with 84 antiretroviral-treated patients who had fasting TG levels from 2.26 to 5.65mmol/l and were randomized to receive DHA or placebo for 48 weeks. TG levels were assessed at baseline, week 4 and every 12 weeks. Body composition was assessed at baseline and at week 48. Registered under ClinicalTrials.gov Identifier no. NCT02005900. Patients receiving DHA had a 43.9% median decline in fasting TG levels at week 4 (IQR:-31% to-56%), compared with-2.9% (-18.6% to 16.5%) in the placebo group (P<0.0001). DHA levels and decrease in TG at week 4 in the DHA arm correlated significantly (r=0.7110, P<0.0001). The median reduction in TG levels in the DHA arm was-43.7% (-32.4% to-57.5%), and in the placebo arm+2.9% (-21.3% to+30.1%) at week 12. The difference remained statistically significant at week 48 (P=0.0253). LDL cholesterol levels significantly increased at week 4 by 7.1% (IQR:-4.8% to+35.3%) in the DHA arm but not in the placebo group. No significant changes were observed in HDL cholesterol, insulin, and HOMA-IR during the study. Limb fat significantly increased in both arms, without statistically significant differences between groups (P=0.3889). DHA was well tolerated; only 3 patients experienced treatment-limiting toxicity. Supplementation with DHA reduced fasting TG levels in antiretroviral-treated HIV-infected patients with mild hypertriglyceridemia. DHA was well tolerated with minor GI symptoms. Peripheral fat significantly increased in the DHA group but did not increase significantly compared with placebo.
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