A nutraceutical combination targeting dyslipidemia and subclinical inflammation in HIV patients on stable antiretroviral therapy

DOI:10.1016/j.atherosclerosis.2018.06.646

Bianconi V¹, Schiaroli E², Francisci D², Mannarino MR¹, Barsotti F¹, Spinozzi A, Bagaglia F¹, Baldelli F, Pirro M¹

1Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy 2Unit of Infectious Diseases, Department of Medicine, University of Perugia, Perugia, Italy

Abstract

Introduction: Hypercholesterolemia and chronic lowgrade inflammation increase cardiovascular risk in human immunodeficiency virus (HIV)-infected patients. Statin treatment may be hampered by drug-to-drug interactions when combined with antiretroviral therapy (ART).

Aim: We investigated the effects of a nutraceutical combination (NC) on lipid profile, proprotein convertase subtilisin/ kexin type 9 (PCSK9), subclinical inflammation and arterial stiffness in ART-treated HIV-infected patients.

Methods: This is a crossover interventional study of 26 HIV‐infected patients on stable ART with low density lipoprotein cholesterol (LDL‐C)[100 mg/dL, not receiving any lipid‐lowering treatment. After a 3‐week lipid stabilization period, the effect of a 3‐month oral NC containing red yeast rice‐derived monacolin K 3 mg, berberine 500 mg, policosanol 10 mg, astaxanthin 0.5 mg, folic acid 0.2 mg and coenzyme Q10 2 mg vs no active treatment (noNC) was tested on plasma total cholesterol (TC), LDLC, high density lipoprotein cholesterol (HDL‐C), triglyceride, lipoprotein(a), PCSK9, high‐sensitivity C‐reactive protein (hsCRP) levels and aortic pulse wave velocity (aPWV).

Results: At baseline a significant correlation between plasma PCSK9 levels, age (rho =‐0.49, p = 0.01) and waist circumference (rho = 0.44, p = 0.02) was observed. Treatment effect was significant for the following variables: TC (p<0.001), LDL‐C (p<0.001), PCSK9 (p = 0.04), hsCRP levels (p = 0.03) and aortic PWV (p = 0.02), while no significant treatment effect was observed for HDL‐C, trygliceride and lipoprotein(a) levels, nor for muscle and liver safety parameters.

Conclusions: An oral NC containing low-dose monacolin K and berberine significantly reduces plasma cholesterol and PCSK9 levels, attenuates subclinical inflammation and improves arterial stiness in HIV-infected patients on stable ART.