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Postprandial response to a physiologic caloric load in HIV-positive patients receiving protease inhibitor–based or nonnucleoside reverse transcriptase inhibitor–based antiretroviral therapy^1,2,3

¹ From the Departments of Medicine (AT-G, HNG, and LB) and Pediatrics (SH and RR) and the General Clinical Research Center (WK), Columbia University, New York, NY; the Department of Medicine (JA), St Luke's-Roosevelt Medical Center, Division of Infectious Disease (SR, RM, and WME-S), Harlem Hospital Center and Columbia University, New York, NY; the Department of Medicine, University of California Davis, Davis, CA (BO and LB); and the VA Northern California Health Care System (LB)

Background: Features of the dyslipidemic pattern reported with the use of antiretroviral therapy predict enhanced postprandial lipemia, which is an emerging cardiovascular disease risk factor.

Objective: We evaluated the postprandial response to a physiologic, meal-based challenge in HIV-positive subjects without hyperlipidemia.

Design: We measured hourly lipid, lipoprotein, glucose, and insulin concentrations during a 13-h period in 25 nonwhite patients (13 women, 12 men): 13 receiving a protease inhibitor (PI)-based regimen (6 nelfinavir and 7 indinavir) and 12 receiving a nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimen (6 efavirenz and 6 nevirapine).

Results: Mean fasting HDL-cholesterol concentrations were lower in HIV patients than in healthy subjects without HIV infection matched for age, sex, and ethnicity (z score: –0.81 ± 0.9; P = 0.0001). Fasting triacylglycerol concentrations were not significantly different between HIV-infected patients and healthy subjects but were higher in PI-treated than in NNRTI-treated patients [median (interquartile range): 144 (110–191) and 89 (62–135) mg/dL; P = 0.007]. Average daylong triacylglycerol concentrations, but not incremental concentrations, were higher in the PI group than in the NNRTI group [205% (185–248%) and 125% (78–191%); P < 0.05]. For all HIV-positive patients, the fractional triacylglycerol increase was lower after breakfast than after lunch (20 ± 18% and 42 ± 40%, respectively; P < 0.04). Insulin concentrations were higher in PI-treated than in NNRTI-treated patients [22.6 (13.1–29.8) and 11.8 (7.1–19.1) µU/mL; P = 0.01] and increased in both groups in response to each meal, whereas glucose concentrations increased only after breakfast.

Conclusions: Despite baseline differences, incremental triacylglycerol and insulin responses to a physiologic caloric load among HIV-positive patients were not significantly affected by differences in the type of antiretroviral therapy.

Key Words: HIV • protease inhibitors • nonnucleoside reverse transcriptase inhibitor • NNRTI • antiretroviral treatment • ART • postprandial lipemia • insulin resistance • African Americans