title: Comparative effectiveness of fish oil versus fenofibrate, gemfibrozil, and atorvastatin on lowering triglyceride levels among HIV-infected patients in routine clinical care.
abstract: OBJECTIVE
  The goal of this study was to compare the effectiveness of fish oil, fenofibrate, gemfibrozil, and atorvastatin on reducing triglyceride (TG) levels among a large cohort of HIV-infected patients in clinical care.
  
  
  METHODS
  Retrospective observational cohort study.
  
  
  METHODS
  The primary endpoint was absolute change in TG levels measured using the last TG value pretreatment and the first TG value posttreatment. A pre-post quasi-experimental design was used to estimate the change in TG because of initiating fish oil. Linear regression models examined the comparative effectiveness of treatment with fish oil versus gemfibrozil, fenofibrate, or atorvastatin for TG reduction. Models were adjusted for baseline differences in age, sex, race, CD4⁺ cell count, diabetes, body mass index, protease inhibitor use, and time between TG measures.
  
  
  RESULTS
  A total of 493 patients (mean age, 46 years; 95% male) were included (46 patients receiving gemfibrozil; 80, fenofibrate; 291, atorvastatin; and 76, fish oil) with a mean baseline TG of 347 mg/dL. New use of fish oil decreased TG [ΔTG, -45 mg/dL; 95% confidence interval (CI): -80 to -11] in the pre-post study. Compared with fish oil (reference), fibrates were more effective (ΔTG, -66; 95% CI: -120 to -12) in reducing TG levels, whereas atorvastatin was not (ΔTG, -39; 95% CI: -86 to 9).
  
  
  CONCLUSIONS
  In HIV-infected patients in routine clinical care, fish oil is less effective than fibrates (but not atorvastatin) at lowering TG values. Fish oil may still represent an attractive alternative for patients with moderately elevated TGs, particularly among patients who may not want or tolerate fibrates.
authors.affiliation: *Department of Pharmaceutical Outcome and Policy, University of Florida, Gainesville, FL; †US Food and Drug Administration, Silver Spring, MD; ‡Department of Medicine (HC, MK) and Department of Biostatistics (EB), University of Washington, Seattle, WA; §Department of Medicine, University of Alabama, Birmingham, AL; ‖Department of Medicine, University of California, San Diego, CA; ¶Department of Medicine, University of North Carolina, Chapel Hill, NC; and #Department of Medicine, University of California, San Francisco, CA.
authors.forename: Monica A
authors.initials: MA
authors.lastname: Muñoz
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.forename: Joseph A C
authors.initials: JA
authors.lastname: Delaney
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Brown
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
authors.forename: W Chris
authors.initials: WC
authors.lastname: Mathews
authors.forename: Sonia
authors.initials: S
authors.lastname: Napravnik
authors.forename: James H
authors.initials: JH
authors.lastname: Willig
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Eron
authors.forename: Peter W
authors.initials: PW
authors.lastname: Hunt
authors.forename: James O
authors.initials: JO
authors.lastname: Kahn
authors.forename: Michael S
authors.initials: MS
authors.lastname: Saag
authors.forename: Mari M
authors.initials: MM
authors.lastname: Kitahata
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Crane
mesh_terms: D000328:Adult; D000407:Alabama / Q000453:epidemiology; D000069059:Atorvastatin; D015496:CD4-Positive T-Lymphocytes; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D057186:Comparative Effectiveness Research; D004347:Drug Interactions; D005260:Female; D011345:Fenofibrate / Q000627:therapeutic use*; D005395:Fish Oils / Q000627:therapeutic use*; D015248:Gemfibrozil / Q000627:therapeutic use*; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D006538:Heptanoic Acids / Q000627:therapeutic use*; D006801:Humans; D015228:Hypertriglyceridemia / Q000097:blood / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011758:Pyrroles / Q000627:therapeutic use*; D012189:Retrospective Studies; D012495:San Francisco / Q000453:epidemiology; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood; D014861:Washington / Q000453:epidemiology
chemical_list: D005395:Fish Oils; D006538:Heptanoic Acids; D000960:Hypolipidemic Agents; D011758:Pyrroles; D014280:Triglycerides; D000069059:Atorvastatin; D015248:Gemfibrozil; D011345:Fenofibrate
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