New Results - Same Lipid Problem!

[Lou-ah-vull]

I have my six month bloodwork back with virtually no change from July.  CD 4 is 627, CD% is 48.2 and Viral Load remains undetectable (<20.)

In October, I switched to three times daily niacin to see if that would boost my HDL and lower my sky high triglycerides (525.)  Well, now the trigs are slightly lower at 493 and my HDL declined from 33 to 32!  I see my ID doctor in two weeks and we will talk about my lipid profile.  I am having such good luck with Atripla with no physical side effects, but everything we have tried has not really improved my lipid profile.  I will read up on this and entertain any thoughts you all may have but I sure hope I don't have to switch meds.

I am taking pharmaceutical grade triple strength fish oil 3X a day in addition to being mindful on diet.  In October I was taken off zocor altogether, so I am only taking the niacin.  I realize that two months may be too soon to measure the effectiveness of the niacin, but a glimmer of hope sure would have been nice!

Any thoughts?

Gary

[Assurbanipal]

For me the HDL is really responsive to aerobic exercise if I do enough of it.  But I have to do a lot.   45 minutes at high intensity 5 times a week for a few months brings it up 15 to 20 points, but if I stop or slack off it seems almost directly correlated.

The problem is it is really hard to stick to it.  I'm in my fifties and some days I just have to give up and come back the next day.

Exercise doesn't seem to do much for my triglcerides either (especially over the holidays when I tend to do a little too much baking)

Hope you can find something that works for you

A

[buginme2]

Merck is currently in phase 3 clinical trials of a new cholesterol medication that can raise hdl levels by 70% or so.  The drug is called Anacetrapib.  It is not a statin, but a new class of drug.  Its a long shot but you could see if you could get in on a clinical trial or at least have hope of a new medication sometime in the future.

[eric48]

new cholesterol medication that can raise HDL levels by 70% or so.  The drug is called Anacetrapib.  It is not a statin, but a new class of drug.  

Hi,

To make a long story short, I have pointed out a few time that the only proven medicine intervention that can boost HDL is the inhibition of CETP.

Anacetrapib is CETP inhibitor that has remarkable results, is in phase III, has shown HDL increase as high as 100 %.

Once it hits the markets it is going to be a blockbuster !

Higher HDL is known for having a protective effect. (the framingham study...)

Some cardiologists are wondering whether an artificial increase of HDL by inhibiting CETP would have the same effect, as par their argument, CETP itself may have a role of its own.
Therefore they are calling for end point studies before we can claim victory.

But let's hope CETP inhibition is up to the expectations. Then we will see all dis-lipidimic HIVers take an additional pill.

The Irony is that Anacetrapib is NOT the only CETP inhibitor, there is an other one and it is already FDA approved.

So why does the general, HDL conscious, public not going for that FDA approved CETP inhibitor ?

That is because this CETP inhibitor is 'reserved' for the very 'lucky' class of people who have a very specific 'condition'.

So who gets that lucky ? Guess who ?

Do not look too far: HIVERs !

The only FDA approved medicine that is a CETP inhibitor is... Nevirapine (Viramune)

Does it increase HDL for real ? It sure did for ME.

(I have listed relevant articles and my cholesterol 'improvements' here:

http://forums.poz.com/index.php?topic=33062.0

my HDL went from 35 to 78 !

)

If you consider that Atripla is once a day Efavirenz + Truvada and that virologically speaking Viramune is very similar, then
once a day Viramune + Truvada (viramune is 'officially twice a day, but many take it once a day and the extended release trials came out successfull
so you may consider it as a once a day...) would be a viable alternative to Atripla + Anacetrapib

Any thoughts?

Well, could be worth discussing it with your doctor ...

Mine offered me this option, and, while I was a bit anxious at the beginning (since some people may have a severe rash at initiation), if one can have it, it is a very easy to take meds.
So I am quite happy with the HDL 'benefits'

(and if nevirapine does not work for you, you can still go back to old Efavirenz)

Just a suggestion, of course...

Eric

[eric48]

BTW that 48 % is awesome ! congrats Eric

[aztecan]

Hey Gary,

I feel your pain. I have the same problems, as you know.

The only way I have been able to drop my lipids to a livable level was a combination of the fish oil (6,000 mgs a day), Niaspan (750 mgs a day taken with an aspirin to inhibit flushing), eating a mainly vegetarian/Mediterranean diet with no red meat and more fish and legumes (beans/tofu) and exercising at least two hours a day three times a week.

Even with that, my numbers are not outstanding, but they are livable.

I hope you find a way to control yours too.

HUGS,

Mark

[elf]

Some general tips:

1. Mediterranean diet with a lot of fish
   (no red meat, no shellfish [except for clams and mussels], no cheese other than fat-free ricotta)
2. No sweets, no sugar, no fruits (fructose in fruit is really bad for lipids),
   if you cannot live without something sweet, put a drop of artificial sweetener in your coffee/tea,
   or have a glass of Coca Cola Zero
3. aerobic exercise (every day for 90 minutes, jogging is the best)
4. supplements:  omega-3 (I take 2g of normal omega-3 and 3 gels of Lovaza), and niacin (Niaspan)
5. lose some weight

[eric48]

Having done all of the above (except 4, since I do not have a cholesterol problem while under viramune)
I can confirm, as far as I am concerned, that it has done wonders on me...

Eric

[bocker3]

Some general tips:

2. No sweets, no sugar, no fruits (fructose in fruit is really bad for lipids),
   if you cannot live without something sweet, put a drop of artificial sweetener in your coffee/tea,
   or have a glass of Coca Cola Zero

Ummm?  Can you tell me just how fruit (which contain no fats) is bad for lipids?  This is exactly the opposite of everything I have ever heard.  Eating lots of fruits and vegetables is good for controling lipids.


Gary,

sorry you are having so much trouble with this.  Wish I had more to offer, but the advice on cutting back/out red meat, eating more veggies and fruit, increasing exercise and losing weight are probably the right moves.  Any particular reason for cutting out the Statin?  although, I didn't think Zocor should be given with Atripla -- I switched from Zocor to Lipitor when I started it.

Mike

[Lou-ah-vull]

My regular doctor in concert with my ID doctor cut out the zocor in October when my trigs increased to 525.  Neither of them liked the statin with my Atripla (although it is not contra-indicated,  you just have to increase the statin...I was taking 80 mg zocor.)  We replaced the zocor with 3x a day niacor (a form of niacin.)  I have had no problem at all with flushing (the main side effect) and a modest reduction in trigs (about 5%) in two months.  Maybe this will continue over time...I don't know how to assess the success.  My total cholesterol went back over 200 again though...so I think I should be taking a statin.  I read the piece in the AidsMeds news earlier this week about lipitor and I will ask about that when I meet my ID doctor a week from Thursday.

I am already doing all the other steps the others suggested (and I agree with you about fruits,)  I really believe my trigs are high because of the Atripla.  The real decision is whether I should try a more lipid friendly regimen instead.  My non-lipid bloodwork is fantastic so I guess this would be as good a time as any. 

I will continue to digest the suggestions and experiences and will report back after I talk to my ID doctor next week.

Gary

[eric48]

A/ My personal experience supports that fruits, as far as I am concerned, help me put on weight. as much vitamin and fiber can be taken out of vegetables. Here again, it is everyone's body, not everyone reacts the same, but, finding, on myself, that moving the cursor a bit more towards vegetables (and away from fruits) is favorable was interesting (since it kind of goes against generally accepted concepts)

B/ the simplified concept is that (most) people who have too much sugar in blood (too much intake or sugar/insulin resistance) will have to store it. and the storage form of energy (in humans) is fat. The opposite is true also: a fat-rich diet increases your blood sugar. The effect on TG may not be direct, but effect on weight may be more visible.

If you would like to rank how easy/difficult it is to modulate one's lipids either by medication/lifestyle/diet, I think the ranking would be:

easiest : LDL
difficult : TG
very difficult : HDL

the following article provides a recent and comprehensive overview of the issue:

http://www.iasusa.org/pub/topics/2010/issue3/112.pdf

I would recommend that you have it at hand when the discussion with doctor comes up and you have underlined your points of interest

Interestingly enough, it shows that, while PIs have a fairly bad reputation, it not true for all PIs

it also demonstrate that it is not a CLASS effect but a MED effect.

My personal experience confirms the language used in that article that nevirapine and lavimudine (I take both) have a positive impact on HDL.

While I understand your desire not to change regimen, you may want to put it in perspective:

the risk of a switch are:
- side effects
- virologic failure.

My understanding is that, (after confronting the MEDS profiles with your resistance profile, of course), for a switch WITHIN the SAME class, the risk are limited to side effects.

So changing regimen within the same class, is not of the same nature as changing class. And you can always go back to the initial regimen

When I started on Abacavir + Lavimudine+ Nevirapine, which is NOT, by far, the most popular, I read the European Guidelines, which state about this regimen that doctor has to weight the risks and benefits.

I decided to take the risks, and you can be sure I was real serious about seeing those 'benefits'.

I can only confirm that, as far as I am concerned, those claims about TG and HDL turned out true (for me).

Hope this helps

Eric

 
 

[gerry69]

My experience supports the fact that if you want to

rank how easy/difficult it is to modulate one's lipids either by medication/lifestyle/diet, I think the ranking would be:
easiest : LDL
difficult : TG
very difficult : HDL

In my own case my numbers trigs were although not yet stratospheric were trending up(somewhere in the range of 350-400), in addition my HDL was pretty much rock bottom and my LDL was high.

My diet was already pretty good -- IN addition to excercise -- I started taking fish oil capsules and the doc pt me on a statin and the maximum dose of NIASPAN (3000 mg).......Because we didn't want to overtax my liver we started the NIASPAN wih a dose of 500 mg......That had the added advantage of allowing us to guage my bodies tolerance as well as response....it toke some time before things got back on track...as I recall as much as six months...it toke some time before things started to move in the righ direction......

to alleviate the possibility of flushing I take it before I go to sleep......and only arely is it so bad as to disturb my sleep........

For the statin we picked Lipitor because based on was known at the time it seemed to be the best choice -- best being a completely relative term -

A recent article on AIDSMeds referred to the authors conclusion that
“Current recommendations include treatment of HIV-associated [cholesterol and triglyceride problems] with statins and emphasize the use of [Pravachol] or [Lipitor]. Our findings are consistent with the recent British guidelines that include a recommendation to use [Crestor],”

You might want to check it out --

http://www.aidsmeds.com/articles/hiv_statin_crestor_1667_19713.shtml

[Lou-ah-vull]

I have checked out that article and like you I am on the maximum dose of niacor (3x a day.)  I have been using the niacin since early October and never once had a problem with flushing (knock on wood.)  In fact, I quit taking the aspirin (what a pain in the neck...30 minutes before each time) and still did not have a problem with flushing.  After about two and a half months, my trigs are down about 30 pts (from 525 to 493) which is about a 5% reduction.  This may be considered good for only two and a half months...I was hoping others might know how to judge that.  My good HDL is down from 33 to 32!  It has never been over 40 in my adult life.

I did post this on Ask the Experts on The Body and I will post the answer I get from the doctors (usually takes four or five days.)  I will also speak with my ID doctor a week from Thursday and will post what he tells me too.  I am grateful for this site for the exchange of information and the opportunity to vent with others who have been down the same or similar roads.  In the grand scheme of things, I am very fortunate to be in fairly good health.  Heaven knows, others on here have much more difficult problems.

Thanks!

Gary

[gerry69]

In the grand scheme of things, I am very fortunate to be in fairly good health.  Heaven knows, others on here have much more difficult problems.

  I couldn't agree more Gary especially given what the prognosis was at the time of my HIV diagnosis..........

Anyway seeing your initial post got me thinking with respect to what the actual facts were in my particular case.  As I have never been one to keep the details of the lab work in my head I went back and toke a look.  The initial 'discovery' occurred in 2002 so it has been a while.  Looking at the notes I made on the monthly lab results with respect to the relationship between the meds and the numbers while the triglycerides started to come down almost immediately it toke a good six months to reach what we thought was a stable number......

Based on my family history the doctor managing this process (who was a cardiologist) was more concerned with 'optimizing the overall result' and not just the triglycerides..........

Luckily for me we were able to find a match between what the studies indicate and my bodies response.
Hopefully you can too. 

[aztecan]

Gary, one thing my doctor told me, and others have mentioned it, is to lose weight. Sometimes just 10 pounds can make a difference.

Another thing I had to do was change meds. I was on a PI (boosted Lexiva), which I switched out for Isentress.

The drop in my lipids was substantial and rapid.

Just an FYI.

HUGS,

Mark

[eric48]

Hi,

this is new and may be of interest to you

http://www.iasusa.org/pub/topics/2010/issue5/164.pdf

Cheers
Eric

[buginme2]

On a positive note, your other numbers are awesome:
Diagnosed Oct. 2005
10/05:  367 (26.2%), 24556 VL
01/06:  344 (24.6%), 86299 VL
04/06:  374 (22.0%), 87657 VL
Began HAART 05/15/06, Combivir/Kaletra
07/06:  361 (27.8%), 1299 VL
10/06:  454 (32.4%), 55 VL
01/07:  499 (38.4%), <50
02/07 Switched to Atripla
04/07:  566 (37.7%), <50
08/07:  761 (42.3%), <48
06/08:  659 (47.1%), <48
01/09:  613 (43.8%), <48
07/09:  616 (47.4%), <48
01/10:  530 (44.2%), <48
07/10:  636 (48.9%), <48
01/11:  627 (48.2%), <20

[NycJoe]

Thanks for the articles.  I might take a copy to my Dr.  I can not get my HDL above 33 to save my life.  My overall cholesterol is 156.  All I take is a lopid and lovaza.  I was going to ask her about niacin.   Hopefully between that and some more exercise I can raise the HDL above 40 for once!

Joe

[Lou-ah-vull]

I had my ID consult on Thursday and he wants me to continue the Atripla and focus on lifestyle (diet, exercise) to work on the lipid levels.  He wants me and my internist to discuss what statin I should take in lieu of the the fact that I had virtually no success with zocor.  He says his patients have done well with carefully monitored Lipitor (and he is less confident about Crestor.)  I have only been on the niacin for a few months and I have been taking the equivalent of 600 mg of concentrated fish oil daily.  I am asking about Lovaza as I am on the cusp of the 500 TG level for this medication.  I have not been rigorous with diet and even less so with exercise so now I will make a much more concerted effort.  No doubt, my diet and lack of exercise has complicated my situation. 

Like others on here, I have NEVER gotten much about 35 on HDL.  My doctor says there may be genetic factors at work there. 

I appreciate everyone's thoughts, suggestions, articles, and continued stories.  I am waiting on an answer from "Ask the Experts" on The Body.  I will post what I learn from there.

Gary

[eric48]

This week I had the yearly monitoring with cardiologist/biochemist/nutritionist/etc.

I got commended for my good numbers in that respect

After 25 years of careful prevention, a one time error has lead me in the once dreaded infection. It makes me so sad...

Therefore, whenever I  get some 'good news' it really cheers me up...

I do not feel too comfortable in participating in a thread about a problem I do not have, but, it is a problem I should normally have (with high obesity and similar problems in my family)
(among my blood relatives, I am the only one on the safe side, and, they, really have a problem...)

I dearly hope you can solve the problem, because, it really feels good when you can tell all these doctors that da bug is the only 'problem' you have.

I have not used any medicine to reduce my (now-behind-me) obesity issues, therefore, my own experience supports what elf stated here:

http://forums.poz.com/index.php?topic=36194.msg450950#msg450950

It is indeed a lot of daily effort and commitment, but, if you feel that there is room for improvement in your life style, I would certainly encourage you.

I was very demanding in my choice of meds that they would not ruin several years of commitment to healthier food/exercises/lifestyle.

With my family background I had never imagined that it could worked, but it did, for me. I hope you will give it a very serious try

Good luck

Eric



 

[Assurbanipal]

I was travelling for a couple of weeks and didn't log on, but I kept thinking about this thread and about whether I'd stressed enough how much mileage goes into the exercise component.

A few years back, I'd read an article on the New York Times "well" blog that said that men who ran 40-60 miles per week had very few cholesterol issues.  That seemed a bit unattainable to me back then, but I set it as a long term goal and tried to slowly work up to it.  At about 25 miles per week is when I saw the good effects on HDL kick in.  It took me about 3 years of gradually working up to it to get there, and now I'm at about 28 miles trying to get to 30.  But starting slow and sticking with gradual increases in intensity and time really do add up over the years. ( Of course, YMMV )


Good luck

A

[eric48]

It took me about 3 years of gradually working up to it to get there [....]  But starting slow and sticking with gradual increases in intensity and time really do add up over the years.

Same here...

Small increments... One step after the other and you will be amazed what you can achieve after ... well ... it took me also 3 years... But with small increments you never feel fed up. The body gradually adjusts and allows more.

My own self-observation also supports that it does not reward gradually, in a linear fashion, but, there seems to be thresholds and plateaus, so it requires long term commitment and gradual increases seems the right approach to me.

Eric

[Lou-ah-vull]

The verdict is in (at least for the moment)

I start on Lipitor tomorrow 1x a day
I continue on 500 mg niacin 3x a day
I continue on OTC fish oil (I am using pharm grade triple strength) 2x a day (equivalent o 6 regular capsules)
I continue on Atripla
Fasting lipids and liver enzymes in two months.
Better diet (virtually no simple sugars and high glycemic stuff) and regular exercise.

Another forum member and I are trying to help each other stay motivated to lose weight and improve diet.

Will keep everyone posted.  Still haven't heard from The Body.  Thanks for the suggestions and articles.

Gary

[weasel]

   Hey Gary ,
                    Last spring my triglycerides were off the scale !

                   My LDL's  were high and HDL's low !

       I changed to NO BEEF ! NO fast foods !

       In Dec. I had a fasting test and my    Levels were almost perfect !

       I do not really  exercise . I do alot of building and moving thou .

      My Main Meats are chicken & Bison meat !

      I was told Bison would LOWER my triglycerides  , Seems to work for me .

                                                    good luck with yours ,
                                                                                          Carl

[eric48]

Hi,

Among the various strategies explored in this thread, the OP clearly desires NOT to switch and expresses strong willingness to resolve the
TG issue by any means other than a switch.

I dearly hope this approach will be successfull. Lifestyle /diet intervention will be beneficial , no doubts.

In the (not desired) event that the switch option comes back on the table and in reference to one of my post on this thread, today, I have come across an article
that you may want to keep for future reference, just in case.

the article is about Substitution of nevirapine because of efavirenz toxicity in AIDS clinical trials group A5095. It concludes:
Substitution of nevirapine because of efavirenz toxicity was generally safe and efficacious

it is a free article

http://cid.oxfordjournals.org/content/50/5/787.long

I felt that this article could be usefull in the future and therefore, I am posting it, not as an addition to the discussion but to the available documentation.

Cheers

Eric

[Lou-ah-vull]

Thanks.  I am open to a switch, but my ID doctor is set against it at the moment.  He believes the diet changes will make a dramatic difference especially when coupled with lipitor and niacin.  This will be evaluated again in six months including the possibility of regimen change.  His thinking is that I have tolerated Atripla very well with virtually no toxicity (and he believes the drugs in Atripla have been well studied for long term consequences, especially toxicity.)  We would most likely be looking at nevirapine and truveda if I switch.

Gary