Gemfibrozil, one of the standard therapies used to control triglyceride levels, has only modest effects in patients with HAART-associated triglyceride elevations, according to a small randomised study reported this month in the journal AIDS.
The study, conducted by St Vincent’s Hospital in Sydney, randomised 37 men with a median fasting triglyceride level of 5.6mmol/L to receive either gemfibrozil 600mg twice daily or placebo after a four week diet phase.
Triglyceride levels fell by 1.22mmol/L in the gemfibrozil group (-18%) and rose by 0.35mmol/L in the placebo group over 12 weeks, a non-significant difference (p=0.08). The study was powered to detect a difference of at least 2mmol/L between the groups. Only one individual experienced a reduction in triglyceride levels to the normal range.
The authors note that whilst gemfibrozil treatment has resulted in triglyceride reductions of up to 55% in HIV-negative patients, the reduction seen in this study was much smaller (18%), and the authors suggest that further studies should look at higher doses (gemfibrozil was well tolerated in this study) and combination therapy with a statin. However, they also admit that gemfibrozil may not be addressing the root cause of hypertriglyceridemia – ongoing insulin resistance or another metabolic disturbance generated by HAART.
Miller J et al. A randomised, double blind study of gemfibrozil for the treatment of protease inhibitor-associated hypertriglyceridemia. AIDS 16: 2195-2200, 2002.