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 subjects without hyperlipidemia.


METHODS
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) microU/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.
Department of Medicine and the General Clinical Research Center, Harlem Hospital Center and Columbia University, New York, NY, USA.
Asha
A
Thomas-Geevarghese
Subhashree
S
Raghavan
Robert
R
Minolfo
Steve
S
Holleran
Rajasekhar
R
Ramakrishnan
Bernard
B
Ormsby
Wahida
W
Karmally
Henry N
HN
Ginsberg
Wafaa M
WM
El-Sadr
Jeanine
J
Albu
Lars
L
Berglund
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000187:drug effects*; D002784:Cholesterol / Q000097:blood*; D004032:Diet; D002149:Energy Intake; D005260:Female; D017320:HIV Protease Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D006679:HIV Seropositivity / Q000188:drug therapy / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000097:blood*; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period / Q000187:drug effects* / Q000502:physiology; D018894:Reverse Transcriptase Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D014280:Triglycerides / Q000097:blood*
D001786:Blood Glucose; D017320:HIV Protease Inhibitors; D007328:Insulin; D018894:Reverse Transcriptase Inhibitors; D014280:Triglycerides; D002784:Cholesterol