Author(s)

Franco Felizarta, Anthony Scarsella, Homayoon Khanlou, Winston Young, Lisa Ross, Henry Zhao, Keith Pappa, Belinda Ha

AIDS Healthcare Foundation, Los Angeles, California, USA.
GlaxoSmithKline, Research Triangle Park, Durham, North Carolina, USA.
GlaxoSmithKline, Research Triangle Park, Durham, North Carolina, USA..
Pacific Oaks Medical Group, Beverly Hills, California, USA.
Private Practice, Bakersfield, California, USA.
Statworks, Research Triangle Park, Durham, North Carolina, USA.

Background: Managing hypertriglyceridemia in HIV-infected patients often requires multiple pharmacologic strategies. Many protease inhibitors (PIs), one of 6 classes of drugs used to treat HIV, have been associated with hypercholesterolemia and drug interactions. For this study, we examined a dual strategy to manage hypertriglyceridemia in HIV-infected patient taking PIs: 1) switching patients to fosamprenavir (FPV), a PI with fewer drug interactions, and 2) adding prescription fish oil (LOVAZA^?), which has been shown to reduce triglycerides. Methods: This multicenter, 24-week study enrolled 36 patients virologically suppressed (HIV-1 RNA <50 copies/mL) on PI-containing therapy with screening triglyceride levels of 200 - 1200 mg/dL and LDL cholesterol levels ≤160 mg/dL. At baseline, patients were switched to ritonavir (RTV)-boosted fosamprenavir (FPV 1400 mg/RTV 100 mg QD) and any lipid-lowering agents were stopped. At Week 6, LOVAZA 4 g QD was added. Results: Five patients prematurely discontinued due to adverse events (2), non-compliance, lost-to-follow up, and protocol violation. Median triglyceride concentration was 303 mg/dL at screening, 262 mg/dL at baseline, 290 mg/dL at Week 6 (+8% from baseline), and 218 mg/dL at Week 24 (–30% from Week 6). At Week 24, 39% (12/31) of patients had triglycerides <200 mg/dL. Among patients reaching Week 24, 100% (31/31) and 90% (28/31) had HIV-1 RNA <400 and <50 copies/mL, respectively. Conclusions: In this study, a switch to FPV/RTV followed by LOVAZA decreased median triglyceride levels and modestly increased the percentage of patients with triglyceride levels <200 mg/dL while maintaining virologic suppression in HIV-infected subjects with hypertriglyceridemia. Our data suggest that baseline PI may affect the likelihood of achieving triglycerides <200 mg/dL after 18 weeks on study. A larger study would be needed to understand the relative contributions of choice of protease inhibitor and LOVAZA to triglyceride concentrations in HIV-infected patients.

Fish Oil; Fosamprenavir; HIV; Hypertriglyceridemia; Lovaza; Switch; Triglycerides

Felizarta, F. , Scarsella, A. , Khanlou, H. , Young, W. , Ross, L. , Zhao, H. , Pappa, K. and Ha, B. (2012) Impact of Switch to Fosamprenavir and Addition of Lovaza^® for Treatment of Hypertriglyceridemia in HIV-Infected Subjects on Antiretroviral Therapy. World Journal of AIDS, 2, 24-32. doi: 10.4236/wja.2012.21004.