Short-term effects of extended-release niacin on endothelial function in HIV-infected patients on stable antiretroviral therapy.
OBJECTIVE
To assess the short-term effects of extended-release niacin (ERN) on endothelial function in HIV-infected patients with low high-density lipoprotein-cholesterol (HDL-c) levels.


METHODS
Randomized controlled study to determine the short-term effects of ERN on endothelial function, measured by flow-mediated vasodilation (FMD) of the brachial artery, in HIV-infected adults with low HDL-c. Participants on stable HAART with fasting HDL-c less than 40 mg/dl and low-density lipoprotein-cholesterol less than 130 mg/dl were randomized to ERN or control arms. ERN treatment started at 500 mg/night and titrated to 1500 mg/night for 12 weeks. Controls received the same follow-up but were not given ERN (no placebo). Participants were excluded if they had a history of cardiac disease, uncontrolled hypertension, diabetes mellitus, or were on lipid-lowering medications such as statins and fibrates. Change in FMD was compared between arms with respect to baseline HDL-c.


RESULTS
Nineteen participants were enrolled: 89% men, median age 50 years, 53% white/non-Hispanic, median CD4 cell count 493 cells/microl, and 95% of them had HIV RNA below 50 copies/ml. Participants receiving ERN had a median HDL-c (interquartile range) increase of 3.0 mg/dl (0.75 to 5.0) compared with -1.0 mg/dl in controls (-6.0 to 2.5), a P value is equal to 0.04. The median change in FMD was 0.91% (-2.95 to 2.21) for ERN and -0.48% (-2.65 to 0.98) for controls (P = 0.67). However, end of study FMD for ERN was significantly different from controls after adjusting for baseline differences in FMD and HDL-c, 6.36% (95% confidence interval 4.85-7.87) and 2.73% (95% confidence interval 0.95-4.51) respectively, a P value is equal to 0.048.


CONCLUSIONS
This pilot study demonstrated that short-term niacin therapy could improve endothelial function in HIV-infected patients with low HDL-c.
Chow
Dominic C
DC
Hawaii Center for AIDS, University of Hawaii John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96816, USA. dominicc@hawaii.edu
Stein
James H
JH
Seto
Todd B
TB
Mitchell
Carol
C
Sriratanaviriyakul
Narin
N
Grandinetti
Andrew
A
Gerschenson
Mariana
M
Shiramizu
Bruce
B
Souza
Scott
S
Shikuma
Cecilia
C
D023241:Antiretroviral Therapy, Highly Active; D001916:Brachial Artery / Q000187:drug effects / Q000503:physiopathology; D018791:CD4 Lymphocyte Count; D008076:Cholesterol, HDL / Q000097:blood*; D003692:Delayed-Action Preparations / Q000494:pharmacology; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D015497:HIV-1; D006801:Humans; D000960:Hypolipidemic Agents / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D009525:Niacin / Q000494:pharmacology*; D010865:Pilot Projects; D014664:Vasodilation / Q000187:drug effects*
D008076:Cholesterol, HDL; D003692:Delayed-Action Preparations; D000960:Hypolipidemic Agents; D009525:Niacin