Specialty Pharmacy Times: April 2012
Dietary Interventions Prevent Dyslipidemia in Patients Started on HAART
Although the use of highly active antiretroviral therapy (FC) has greatly reduced the morbidity and mortality of patients infected with HIV, it is also associated with the development of adverse effects, particularly metabolic disorders like dyslipidemia. Current guidelines recommend diet as first-step intervention for HIV-infected individuals with HAART-related dyslipidemia, but there is no evidence from randomized trials to support this recommendation.
In a study published in the latest issue of the Journal of the American College of Cardiology, researchers from the University of Rio Grande do Sul in Brazil enrolled 83 HIV-infected patients, naïve from HAART, and randomly assigned them to dietary intervention or no dietary intervention groups for 12 months. Before and after intervention, 24-h food records and lipid profiles were obtained. Data were analyzed by intention to treat.
The researchers found that diet resulted in reduction of percentage of fat intake while controls presented no change in percentage of fat intake. Moreover, plasma cholesterol and low-density lipoprotein cholesterol (LDL-C) increased in the control group and remained unchanged in the diet group. Plasma triglycerides were reduced by diet and increased in the control group. The results demonstrate that diet alone can prevent dyslipidemia in naïve patients recently initiated on HAART.
CDC Says HIV in IV Drug Users Is Decreasing
The Centers for Disease Control and Prevention released a study on March 1, 2012, based on a 2009 survey whose results showed the rate of HIV infection among IV drug users is decreasing since the 1990s. The survey calculated HIV infection among IV drug users at 9%, compared with 18% in the 1990s.
The CDC report also says, however, that HIV testing in this high-risk group has decreased as well. The survey was of 10,000 people in 20 urban areas in the US. Although HIV rates have been falling in the United States, infection still remains high in high-risk groups like young people, IV drug users, and men who have sex with men.
The results of this study, which were released in the Morbidity and Mortality Weekly Report, demonstrate that HIV testing, while increasing in many populations, must be expanded to high-risk groups as well. Resources must be refocused to increase prevention effort and reach more drug users, including offering more used syringe exchange programs to promote using new sterile syringes, promoting condom use, and substance abuse treatment programs.
Hormonal Contraception Safe in Women with HIV
Results of a trial presented on March 7, 2012, at the 19th Conference on Retroviruses and Opportunistic Infections in Seattle demonstrate that hormonal contraception does not accelerate the risk for HIV progression. While prior studies had shown the possibility that hormonal contraception could cause HIV infection to progress, these studies had inconsistent results and could not be used to reach a definitive conclusion.
The present study, conducted by researchers from the University of Washington, Seattle, was a prospective study that enrolled 2269 women with HIV-1 infection from 7 countries in East and southern Africa. CD4 counts, which were all at least 250 cells/mm3 at baseline, were measured every 6 months and viral load was measured at enrollment and at 6 months follow-up.
The primary outcomes included nontraumatic death, initiation of antiretroviral therapy, and decline in CD4 count to below 200 cells/mm3. In 28 of these women, researchers compared the rates of CD4 decline to below 500 cells/mm3 between hormonal contraceptive users and nonusers.
Types of hormonal contraception included injectable hormonal contraception (14.5%) and oral hormonal contraception (4.2%). The researchers found that women using hormonal contraception were at lower risk for a decline in CD4 count to below 500 than women who did not use hormonal contraception. In Africa, young women and girls are at the greatest risk for HIV infection. SPT
Fast Fact: Women comprise 23% of those newly infected with HIV, with an estimated 11,200 new HIV infections in 2009, according to the CDC.
About the Author
Michael C. Wisotsky, PharmD, RPh, practices in Shrewsbury, New Jersey.