Management of hypertriglyceridaemia caused by combination antiretroviral therapy in HIV-infected patients: role of omega-3 polyunsaturated fatty acids at different dosages, compared with fibrates.

摘要

We read with great interest the paper by Falasca et al.,1 dealing with a very favourable efficacy of associated omega-3 fatty acids and rosuvastatin in a patient with extremely elevated serum triglyceride levels, during HIV infection, treated with antiretroviral therapy.Hypertriglyceridaemia represents a frequent untoward event of potent combination antiretroviral therapy (cART), which is characterized in the majority of cases by elevated and persistent abnormalities that require pharmacological treatment with fibrates and/or omega-3 polyunsaturated fatty acids (PUFA), especially when dietary changes and increased physical exercise do not act significantly over time.2"4 Unfortunately, the majority of HIV-infected patients are prone to suffer from a mixed dysli-pidaemia, including both hypertriglyceridaemia and hypercho-lesterolaemia (with reduced serum HDL-cholesterol and increased serum LDL-cholesterol fractions). Hence present therapeutic strategies are still debated, since the more potent association of statins and fibrates puts patients at serious risk of serum creatinkinase rise, while the association of statins plus niacin and ezetimibe still lacks extensive data. As a consequence, since in proportionally young persons elevated choles-terolaemia represents the main target, the association between a potent statin controlling hypercholesterolaemia, plus the safe PUFA supplementation, allows one to contain concurrent hyper-trielvceridaemia without adding toxicitv.