Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Infectious Diseases Department, Hospital Arnau de Vilanova, Universitat de Lleida, Institut de Recerca Biomèdica de LLeida (IRBLleida), Lleida, Spain.
Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Clin Nutr. 2018 Aug;37(4):1340-1347. doi: 10.1016/j.clnu.2017.05.032. Epub 2017 Jun 8.
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 5.65 mmol/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.
HIV 感染患者常伴有高甘油三酯血症。多不饱和脂肪酸可降低 HIV 感染患者的空腹血清甘油三酯（TG）水平。然而，尚不清楚二十二碳六烯酸（DHA）补充剂是否可以降低 HIV 感染患者的高甘油三酯血症并改善脂肪分布。
我们进行了一项随机、双盲、安慰剂对照试验，纳入了 84 名接受抗逆转录病毒治疗且空腹 TG 水平在 2.26 至 5.65mmol/L 之间的患者，他们被随机分配至 DHA 或安慰剂组，接受为期 48 周的治疗。分别在基线、第 4 周和每 12 周评估 TG 水平。在基线和第 48 周评估身体成分。该试验已在 ClinicalTrials.gov 注册，注册号为 NCT02005900。
与安慰剂组相比，接受 DHA 治疗的患者在第 4 周时空腹 TG 水平中位数下降了 43.9%（IQR：-31%至-56%）（P<0.0001）。DHA 组中 DHA 水平与第 4 周 TG 下降呈显著相关（r=0.7110，P<0.0001）。第 12 周时，DHA 组 TG 水平中位数下降了-43.7%（-32.4%至-57.5%），而安慰剂组上升了 2.9%（-21.3%至 30.1%）。第 48 周时，两组间差异仍具有统计学意义（P=0.0253）。第 4 周时，DHA 组 LDL 胆固醇水平显著升高 7.1%（IQR：-4.8%至+35.3%），但安慰剂组无此变化。在整个研究过程中，HDL 胆固醇、胰岛素和 HOMA-IR 无明显变化。两组四肢脂肪均显著增加，但组间无统计学差异（P=0.3889）。DHA 具有良好的耐受性，仅有 3 名患者出现治疗相关的毒性。
在接受抗逆转录病毒治疗的 HIV 感染伴轻度高甘油三酯血症的患者中，DHA 补充剂可降低空腹 TG 水平。DHA 耐受性良好，仅有轻微的胃肠道症状。DHA 组外周脂肪显著增加，但与安慰剂组相比，增加幅度无显著差异。
