Postprandial response to a physiologic caloric load in HIV-positive patients receiving protease inhibitor-based or nonnucleoside reverse transcriptase inhibitor-based antiretroviral therapy

Background: Features of the dyslipidemic pattern reported with the use of antiretroviral therapy predict enhanced postprandial lipemia, which is an emerging cardiovascular disease risk factor. Objective: We evaluated the postprandial response to a physiologic, meal-based challenge in HIV-positive su...

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Published in:	The American journal of clinical nutrition Vol. 82; no. 1; pp. 146 - 154
Main Authors:	Thomas-Geevarghese, A, Raghavan, S, Minolfo, R, Holleran, S, Ramakrishnan, R, Ormsby, B, Karmally, W, Ginsberg, H.N, El-Sadr, W.M, Albu, J
Format:	Journal Article
Language:	English
Published:	Bethesda, MD American Society for Clinical Nutrition 01-07-2005 American Society for Clinical Nutrition, Inc
Subjects:	acquired immunodeficiency syndrome Adult African Americans Aged Americans Antiretroviral drugs apolipoproteins Biological and medical sciences Blacks blood glucose Blood Glucose - drug effects blood lipids cardiovascular diseases Cholesterol - blood Diet drug therapy Energy Intake Feeding. Feeding behavior Female Fundamental and applied biological sciences. Psychology high density lipoprotein high energy diet HIV HIV Protease Inhibitors - pharmacology HIV Protease Inhibitors - therapeutic use HIV Seropositivity - drug therapy HIV Seropositivity - metabolism Human immunodeficiency virus Humans hyperlipidemia Insulin Insulin - blood insulin resistance lipid metabolism low density lipoprotein Male metabolic syndrome Middle Aged patients postprandial lipemia Postprandial Period - drug effects Postprandial Period - physiology postprandial state Protease inhibitors proteinase inhibitors Reverse Transcriptase Inhibitors - pharmacology Reverse Transcriptase Inhibitors - therapeutic use risk factors triacylglycerols Triglycerides - blood Vertebrates: anatomy and physiology, studies on body, several organs or systems United States Therapy Antiretroviral agent RNA-directed DNA polymerase ART African Americans nonnucleoside reverse transcriptase inhibitor antiretroviral treatment postprandial lipemia Lipemia protease inhibitors Human Immunopathology Enzyme Postprandial Transferases Retroviridae NNRTI AIDS Immune deficiency Lentivirus Infection Virus Peptidases Nucleotidyltransferases Treatment HIV Viral disease Hydrolases Insulin resistance Human immunodeficiency virus African American
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Summary:	Background: Features of the dyslipidemic pattern reported with the use of antiretroviral therapy predict enhanced postprandial lipemia, which is an emerging cardiovascular disease risk factor. Objective: We evaluated the postprandial response to a physiologic, meal-based challenge in HIV-positive subjects without hyperlipidemia. Design: We measured hourly lipid, lipoprotein, glucose, and insulin concentrations during a 13-h period in 25 nonwhite patients (13 women, 12 men): 13 receiving a protease inhibitor (PI)-based regimen (6 nelfinavir and 7 indinavir) and 12 receiving a nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimen (6 efavirenz and 6 nevirapine). Results: Mean fasting HDL-cholesterol concentrations were lower in HIV patients than in healthy subjects without HIV infection matched for age, sex, and ethnicity (z score: -0.81 +/- 0.9; P = 0.0001). Fasting triacylglycerol concentrations were not significantly different between HIV-infected patients and healthy subjects but were higher in PI-treated than in NNRTI-treated patients [median (interquartile range): 144 (110-191) and 89 (62-135) mg/dL; P = 0.007]. Average daylong triacylglycerol concentrations, but not incremental concentrations, were higher in the PI group than in the NNRTI group [205% (185-248%) and 125% (78-191%); P < 0.05]. For all HIV-positive patients, the fractional triacylglycerol increase was lower after breakfast than after lunch (20 +/- 18% and 42 +/- 40%, respectively; P < 0.04). Insulin concentrations were higher in PI-treated than in NNRTI-treated patients [22.6 (13.1-29.8) and 11.8 (7.1-19.1) microunit/mL; P = 0.01] and increased in both groups in response to each meal, whereas glucose concentrations increased only after breakfast. Conclusions: Despite baseline differences, incremental triacylglycerol and insulin responses to a physiologic caloric load among HIV-positive patients were not significantly affected by differences in the type of antiretroviral therapy.
Bibliography:	http://www.ajcn.org/contents-by-date.0.shtml ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	0002-9165 1938-3207
DOI:	10.1093/ajcn/82.1.146