UCLA

Background: Although intensive antiretroviral therapies dramatically reduce mortality rates in HIV-infected patients, significant metabolic complications associated with antiretroviral therapy including dyslipidemia have been increasingly reported. Objectives of this study are to determine 1) an effect of individual nutritional counseling on dyslipidemia, particularly LDL-C, among Thai HIV-infected adults with dyslipidemia who were not currently taking lipid-lowering medication 2) predictors of reducing LDL-C in Thai HIV-infected adults receiving a stable of antiretroviral regimen for at least 3 months.

Methods: We conducted a randomized, 24-week study in HIV-infected patients who were on antiretroviral therapy with dyslipidemia and were eligible to initiate therapeutic lifestyle changes according to National Cholesterol Education Program (2002). Participants were randomly assigned into two groups. The intervention group received individual counseling with a nutritionist whereas the control group received general diet advice from a physician. A 24-hr recall technique was used to assess dietary intake for both groups at baseline and at week 24. Lipid profile was measured at baseline, at 12 weeks and 24 weeks of follow up. Predictors (measured at baseline) associated with the reduction of LDL-C in HIV-infected patients were assessed for any reduction in LDL-C and for a reduction of at least 10 mg/dL.

Results: Seventy-two patients were randomly assigned. Of these, 62 (86%) completed lipid profile testing and 59 (82%) completed dietary interview. We found a significant difference in mean reduction from baseline of total cholesterol (8% vs 0%) and LDL-C (13% vs 4%) between the intervention group and the control group at week 24. A significant reduction in weight and in carbohydrate intake in the intervention group was observed. Participants who had good level of knowledge of dyslipidemia were more likely to achieve reduction in LDL-C of at least 10 mg/dL at 24 weeks of follow up.

Conclusions: The effectiveness of individual nutritional counseling in improving dyslipidemia, particularly total cholesterol and LDL-C, among Thai HIV-infected adults with dyslipidemia receiving antiretroviral therapy has been demonstrated. To provide a better care for HIV-infected patients receiving antiretroviral therapy with hyperlipidemia, routine HIV/AIDS care with individualized nutritional counseling integration and adequate knowledge of dyslipidemia provision are recommended.