High incidence of hypertriglyceridemia in a Brazilian cohort of people living with HIV/AIDS undergoing antiretroviral treatment in Belo Horizonte, 2001-2010

Abstract INTRODUCTION: Hypertriglyceridemia incidence should be estimated in HIV-infected patients after antiretroviral therapy (ART) initiation. METHODS: We retrospectively analyzed clinical data of HIV-infected adults at 3 public referral centers. Cumulative and person-time incidences were estimated for patients without hypertriglyceridemia. Survival time and hazard ratio (HR) were estimated by Kaplan-Meier analysis and Cox proportional regression, respectively. RESULTS: Cumulative and person-time incidences were 40.4% and 1.4 cases/100 person-months, respectively. The median period for hypertriglyceridemia occurrence was 47 months. Men and patients with switched ART regimens had increased hypertriglyceridemia risk (HR=3.05 and 3.34, respectively). CONCLUSIONS: Hypertriglyceridemia incidence is high in HIV-infected patients undergoing ART.

PEG-asparaginase induced severe hypertriglyceridemia

Asparaginase (ASP) is an effective chemotherapy agent extensively used in children with acute lymphocytic leukemia (ALL). There has been a recent interest in using ASP in adults with ALL, particularly the less toxic pegylated (PEG) formulation. Hypertriglyceridemia (HTG) is a rare complication of PEG-ASP therapy. We report two cases of obese patients who developed severe HTG after receiving PEG for ALL. Both patients were incidentally found to have severe HTG (TG of 4,330 and 4,420 mg/dL). In both patients, there was no personal or family history of dyslipidemia or hypothyroidism. There was no evidence of pancreatitis or skin manifestations of HTG. Both patients were treated with PEG cessation, low-fat diet and pharmacotherapy. Both patients were re-challenged with PEG, with subsequent increase in TG but no associated complications. TG returned to baseline after discontinuing PEG and while on therapy for HTG. A literature review of PEG-induced HTG in adults demonstrated similar results: asymptomatic presentation despite very severe HTG. HTG is a rare but clinically important adverse effect of PEG. Underlying obesity and/or diabetes may represent risk factors. Clinicians should monitor TG levels during PEG therapy to avoid TG-induced pancreatitis.

Evaluación del riesgo cardiovascular en trabajadores de institución financiera de la ciudad de Guatemala / Evaluation of the cardiovascular risk in workers of financial institution of the city of Guatemala

Las enfermedades cardiovasculares son una epidemia a nivel mundial y en países en vías de desarrollo, laincidencia y prevalencia han ido en aumento. Objetivo: El objetivo general fue determinar la prevalencia defactores de riesgo para el desarrollo de enfermedad cardiovascular en un grupo de personas económicamente activas. Métodos: Estudio descriptivo transversal que incluyó a todos los trabajadores de la institución que voluntariamente dieron una muestra de sangre y de orina, y se sometieron a una evaluación clínica durante los meses de junio de 2011 a julio del 2012. Resultados: incluimos 532 participantes, edad promedio 38años(19-65años), 69% de sexo masculino, 23% hipertensión arterial, 7% pre-hipertensión, 8% de tabaquismo, obesidad 16%, 36% sobrepeso, 35% hipercolesterolemia, 31% hipertrigliceridemia, 59% HDL<40mg/dl, 62% LDL >100mg/dl, glicemia preprandial alterada 4%, 14% hiperuricemia, 1% muy alto riesgocardiovascular, 17% alto riesgo. Conclusiones: Los factores de riesgo cardiovascular tienen una alta prevalencia en la población de estudio, a pesar de tratarse de una población joven.

Cardiovascular diseases are epidemic globally and in developing countries, the incidence and prevalence have increased. Objective: The objective was to determine the prevalence of risk factors for the development of cardiovascular disease in a group of economically active people. Methods: A cross sectional study that included all employees of the institution who voluntarily gave a blood sample and urine, and underwent a clinical evaluation during the months of June 2011 to July 2012. Results: We included 532 participants, meanage 38years (19-65años), 69%male, 23% hypertension, pre hypertension 7%, 8% smoking, obesity16%,36% overweight, 35% hypercholesterolemia, hypertriglyceridemia 31%, 59%HDL <40mg/dL, 62%LDL> 100mg/dl, altered fasting glucose4%, 14% hyperuricemia, 1% very high cardiovascular risk, 17% higher risk. Conclusions: Cardiovascular risk factors are highly prevalent in the study population, despite being a young population.

Seguimiento fármaco-terapéutico en pacientes ambulatorios con tratamiento anti-retroviral / Pharmaceutical follow up of antirretroviral treatment in outpatients

Adherence to antiretroviral therapy is key contributor to decreasesing morbidity and mortality from HIV/ AIDS infection. However, it is affected by treatment-related factors including the multiple adverse reactions and interactions arising from chronic polypharmacy. In order to determine drug-related problems, 66 outpatients from Hospital Carlos Van Buren on antiretroviral therapy were monitored. 100 % had medication-related problems and 46.1% of those problems were related to the safety of the therapy. Hypertriglyceridemia associated to the combined use of both nucleoside reverse transcriptase inhibitor and a non-nucleoside reverse transcriptase inhibitor was the most frequent adverse reaction. Results show that pharmacological monitoring of patients on antiretroviral treatment is necessary for the early identification of drug-related problems and for the proposal of alternatives that promote therapeutic safety and efficacy.

La adherencia al tratamiento anti-retroviral es un pilar fundamental en la reducción de la morbi-mortalidad de la infección por VIH/SIDA. Sin embargo, se ve dificultada por ser un tratamiento que involucra numerosos medicamentos administrados de forma crónica, con posibilidad de presentar reacciones adversas y/o interacciones. Se realizó un seguimiento farmacoterapéutico a 66 pacientes ambulatorios con tratamiento anti-retroviral del Hospital Carlos Van Buren. El 100% de los pacientes presentó problemas relacionados con medicamentos, afectando en 46,1% a la seguridad de la terapia. La reacción adversa más frecuente fue hipertrigliceridemia, principalmente asociada al uso de dos inhibidores nucleosídico de la transcriptasa reversa con un inhibidor no nucleosídico de la transcriptasa reversa. Los resultados permiten concluir que la monitorización farmacológica de pacientes con tratamiento anti-retroviral identifica en forma precoz los problemas relacionados con medicamentos, favoreciendo la seguridad y eficacia de la terapia propuesta.

Montelukast Induced Hypertriglyceridemia.

Montelukast a LT4 receptor antagonist is a prophylactic agent used in chronic asthma, to improve asthma control and reduce the frequency of asthma exacerbation. Advantage of Montelukast is, it is well tolerated in both adult and children upto 6 years of age. Suspected adverse effect reported to U.K, CSM follow the launch of Montelukast are anaphylaxis, angioedema, urticaria, chest pain, vertigo, athralgia, fever. Further suspected side effects are nightmare, palpitation, and sweating and Churg Strauss syndrome. Hypertriglyceridemia associated with this agent is rarely found in any published medical report or literature. This is a case of a male patient who was suffering from chronic asthma since childhood, developed allergic rhinitis since November´10. He developed hypertriglyceridemia and associated lipid profile abnormality after taking Montelukast and was also receiving salbutamol inhalation since childhood. His lipid profile before Montelukast administration was normal. Routine investigation done 4 months following drug intake shows serum triglyceride to be 732mg/dl.Montelukast was immediately withdrawn, but salbutamol was continued The triglyceride level reaches near the base line 4 months following drug withdrawal. This case highlights a rare case of Montelukast induced hypertriglyceridemia. Physician should be vigilant of the fact that Montelukast can induce hypertriglyceridemia following therapy with it.

Fructose and cardiometabolic disorders: the controversy will, and must, continue: [review]

The present review updates the current knowledge on the question of whether high fructose consumption is harmful or not and details new findings which further pushes this old debate. Due to large differences in its metabolic handling when compared to glucose, fructose was indeed suggested to be beneficial for the diet of diabetic patients. However its growing industrial use as a sweetener, especially in soft drinks, has focused attention on its potential harmfulness, possibly leading to dyslipidemia, obesity, insulin resistance/metabolic syndrome and even diabetes. Many new data have been generated over the last years, confirming the lipogenic effect of fructose as well as risks of vascular dysfunction and hypertension. Fructose exerts various direct effects in the liver, affecting both hepatocytes and Kupffer cells and resulting in non-alcoholic steatotic hepatitis, a well known precursor of the metabolic syndrome. Hepatic metabolic abnormalities underlie indirect peripheral metabolic and vascular disturbances, for which uric acid is possibly the culprit. Nevertheless major caveats exist (species, gender, source of fructose, study protocols) which are detailed in this review and presently prevent any firm conclusion. New studies taking into account these confounding factors should be undertaken in order to ascertain whether or not high fructose diet is harmful.

Sirolimus en trasplante de órgano sólido pediátrico: Experiencia en 5 casos / Use of Sirolimus in five pediatric patients undergoing solid organ transplantation

Sirolimus (SRL) is an immunosuppressive drug increasingly used in children undergoing solid organ transplantation. SRL does not cause glucose intolerance, hypertension, nephrotoxicity or neurotoxicity offering significant potential advantages over calceneurin inhibitors (CM). Aim: To report five children treated with SRL. Material and methods: A retrospective review of four children undergoing orthotopic liver transplantation (OLT) and one undergoing renal transplantation with recurrent acute rejection (RAR), chronic rejection (CR) or toxicity due to CM, treated with SRL between June 2001 and November 2006. Results: As primary immunosuppressive therapy, all patients received 3 drugs: CM (Tacrolimus (FK) or Cyclosporine), mycophenolate mofetil and steroids. Mean age at treatment with SRL was 98 months. Children undergoing OLT had a ¡ate introduction of SRL (mean time after OLT: 37 months), and mean follow-up was 24 months. In this group rescue indications of SRL were RAR in one, CR in one, thrombotic thrombocytopenic purpura (TTP) in one, food allergy in one and other CM toxicity in three. Only one did not experience adverse events due to SRL, but no one required discontinuation of SRL. There were remissions of RAR, CR, TTP and food allergy. The patient with RT was switched from FK to SRL at day 18th after RT, but he had severe neutropenia that led to discontinuation of SRL. Conclusions: SRL may be useful in pediatric solid organ transplant recipients suffering from RAR, CR, TTP, food allergy and CM toxicity. Careful attention should be directed to detect side effects and avoid severe complications.

Efeito da fibra solúvel sobre a hipertrigliceridemia e perfil imunológico de indivíduos HIV positivo em uso de terapia anti-retroviral de alta atividade / Effect of soluble fiber on the hypertriglyceridemia and immunological profile of HIV positive individuals in use of antiretroviral therapy for high-activity

O advento da utilização da terapia anti-retroviral de alta atividade (HAART), a partir de 1996, representou um profundo impacto na história natural da infecção pelo HIV, promovendo uma importante e sustentada supressão na replicação viral, elevando a sobrevida e a qualidade de vida dos pacientes soropositivos. No entanto, gradualmente, foi se observando que a terapia antiretroviral é acompanhada de alterações metabólicas, como dislipidemia, principalmente hipertrigliceridemia, resistência insulínica, hiperglicemia elipodistrofia, isto é, redistribuição da gordura corporal. Ensaios epidemiológicos demonstram correlação entre os níveis elevados de triglicerídeos (TG) e maior incidência de doença arterial coronariana (DAC). Autores sugerem a intervenção dietética como parte do tratamento da hiperlipidemia, incluindo aumento da ingestão de fibra solúvel (10g-25g/dia). Há estudos demonstrando que tanto o colesterol quanto os triglicerídeos séricos diminuem com a utilização de fibra alimentar. Alguns observaram redução apenas nos níveis séricos de triglicerídeos, enquanto que outros não verificaram alteração no metabolismo lipídico. O objetivo do presente estudo foi avaliar o efeito da fibra solúvel® (goma guar parcialmente hidrolisada) suplementar sobre a hipertrigliceridemia e o perfil imunológico de indivíduos HIV positivo em tratamento com HAART. Foram estudados 19 pacientes HIV positivo com hipertrigliceridemia (níveis séricos maior ou igual a 150 a menor que 500mg/dL), sendo 63,16% do sexo masculino e 36,84% feminino, com média de idade de 43,52 mais ou menos 9,22 anos. Esses indivíduos utilizavam o mesmo esquema HAART há pelo menos seis meses, sem mudança da terapia durante o estudo e receberam 20g de fibra solúvel® por dia, durante quatro meses, em horários pré-definidos...

Bezafibrate for the treatment of hypertriglyceridemia in HIV1-infected patients on highly active antiretroviral therapy

The use of highly active antiretroviral therapy (HAART) in HIV-infected patients has been associated with the development of risk factors for cardiovascular diseases (CD) including dyslipidemia and insulin resistance, hypertriglyceridemia being the most frequent metabolic disturbance in these patients. Fibrates are indicated when hypertriglyceridemia is accentuated and persists for over six months. We evaluated the efficacy and safety of bezafibrate for the treatment of hypertriglyceridemia in HIV-infected individuals on HAART. All patients received 400mg/day of bezafibrate and were evaluated three times: Mo (pre-treatment), M1 (one month after treatment), and M2 (six months after treatment). Fifteen adult individuals, eight males and seven females with mean age = 41.2 ± 7.97 years and triglyceride serum levels > 400mg/dL were included in the study. Smoking, alcohol ingestion and sedentarism rates were 50 percent, 6.66 percent and 60 percent, respectively. Family history of CD, hypertension and diabetes mellitus was reported in 33.3 percent, 40 percent and 46.7 percent of the cases, respectively, while dyslipidemia was reported by only 13.3 percent. More than half of the patients were using a protease inhibitor plus a nucleotide analog transcriptase inhibitor. Eutrophy and tendency toward overweight were observed at all three study time points. There were significant reductions in triglyceride serum levels from Mo to M1 and from Mo to M2. No significant changes were observed in the serum levels of creatine phosphokinase, hepatic enzymes, CD4+, CD8+ and viral load. Therefore, bezafibrate seems to be safe and effective for the reduction of hypertriglyceridemia in HIV-infected patients on HAART.

Magnesium deficiency increases oxidative stress in rats.

Magnesium deficiency has been implicated in the development of atherosclerosis and late diabetic complications, diseases often associated with increased oxidative stress. Present study was carried out to examine the effect of magnesium deficiency on oxidative stress and total radical trapping antioxidant parameter (calculated) in rats and correlate it with the development of free radical mediated diseases. Male Wistar rats were divided into two groups and pair fed for six weeks with low magnesium diet (70 mg/kg) and control diet (990 mg/kg) prepared synthetically. Deionized water was given ad libitum. Low magnesium diet caused a significant decrease in plasma and red blood cell magnesium levels. A marked increase in plasma malondialdehyde and corresponding decrease in total radical trapping antioxidant parameters (calculated) were observed in the low magnesium diet group than control group. The level of plasma glucose increased moderately in the low magnesium diet group. Hypertriglyceridemia and significantly decreased plasma HDL (high density lipoprotein)-cholesterol levels were observed in the low magnesium diet group. The results clearly demonstrate that magnesium deficiency is associated with increased oxidative stress through reduction in plasma antioxidants and increased lipid peroxidation suggesting that the increased oxidative stress may be due to increased susceptibility of body organs to free radical injury.