Dietary Intervention Prevents Dyslipidemia Associated With Highly Active Antiretroviral Therapy in Human Immunodeficiency Virus Type 1-Infected Individuals

Objectives The purpose of this study was to evaluate the efficacy of dietary intervention on blood lipids of human immunodeficiency virus (HIV)-1-infected patients who are started on highly active antiretroviral therapy (HAART). Background Current guidelines recommend diet as first-step intervention for HIV-1-infected individuals with HAART-related dyslipidemia, but there is no evidence from randomized trials to support this recommendation. Methods Eighty-three HIV-1-infected patients, naive from HAART, were randomly assigned to HAART with dietary intervention (diet group, n = 43) or HAART without dietary intervention (control group, n = 40) for 12 months. Diet, according to the National Cholesterol Education Program, was given every 3 months. Before and after intervention, 24-h food records and lipid profile were obtained. Data were analyzed by intention to treat, using mixed-effects models. Results Diet resulted in reduction of percentage of fat intake (from 31 +/- 7% to 21 +/- 3% of calories), while controls presented no change in percentage of fat intake. Plasma cholesterol (from 151 +/- 29 mg/dl to 190 +/- 33 mg/dl) and low-density lipoprotein cholesterol (from 85 +/- 24 mg/dl to 106 +/- 31 mg/dl) increased in the control group and were unchanged in the diet group. Plasma triglycerides were reduced by diet (from 135 +/- 67 mg/dl to 101 +/- 42 mg/dl) and increased in the control group (from 134 +/- 70 mg/dl to 160 +/- 76 mg/dl). After 1-year follow-up, 21% of patients who received diet had lipid profile compatible with dyslipidemia compared with 68% (p < 0.001) of controls. Conclusions Among HIV-1-positive individuals naive of previous treatment, diet prevents dyslipidemia associated with HAART. (Effect of Nutritional Intervention on the Lipid Profile of HIV-Positive Patients Who Start HAART: a Randomized Trial; NCT00429845) (J Am Coll Cardiol 2012;59:979-88) (C) 2012 by the American College of Cardiology Foundation