HIV infection confers cardiovascular risk through multiple pathways, including dyslipidemia and chronic inflammation. We conducted the longest randomized placebo-controlled trial of high-dose omega-3 fatty acids in HIV-infected subjects to date, to evaluate their long-term effects on lipids, inflammation, and vascular function.
HIV-infected subjects on stable ART were randomized to either 4 grams daily of purified omega-3 fatty acids or placebo for 24 months. The primary outcomes were the effects of the intervention on triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and C-reactive protein (CRP); the secondary outcomes were their effects on brachial artery reactivity and on arterial stiffness measured by pulse wave velocity (PWV). Lipids, CRP, and vascular function markers were compared between treatment and placebo groups at pre-specified time points during the trial, as were changes in these parameters from baseline.
Of 117 participants (mean age 51 years, 21% female) allocated to placebo (n=56) or treatment (n=61), 95% were virologically suppressed, with a mean CD4+ count of 648 cells/mL. At 24 months, omega-3 fatty acids decreased median TG and CRP more than placebo (ΔTG, -68mg/dL vs. -22mg/dL, p=0.041; ΔCRP, -0.3 vs. +0.6 mg/L, p=0.008). There were no significant differences in HDL-C or brachial artery reactivity between groups. We noted a trend towards reduced carotid-femoral PWV over 24 months in the treatment versus placebo groups (ΔPWV, -46 ms-1 vs. +18 ms-1, p=0.1). Serious adverse events did not differ between treatment groups.
Long-term omega-3 fatty acid supplementation reduces TG and may mitigate chronic inflammation in people with HIV, as demonstrated by a decline in CRP. The study findings suggest that if omega-3 fatty acid supplementation does have a true effect on vascular function, more than 24 months of treatment would be required for this effect to be appreciable. Given our success in managing HIV infection, we are now aiming to optimize the duration and quality of life for people living with HIV/AIDS, for whom interventions such as omega-3 fatty acids may be of benefit.
Figure 1A. Triglycerides throughout the trial.
Figure 1B. C-reactive protein throughout the trial.
J. Gerrior-Schofield, None
F. F. Zhang, None
A. Tang, None
J. Kuvin, None
A. Mangili, None
C. Wanke, None