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On ARV and Battling Dyslipidemia

Jul 28, 2013

Hi, doc.

First, thanks for your (and your The Body team's) responses to the people asking questions here. Been reading and learning a lot.

I am on Combivir and Sustiva and it is giving me dyslipidemia. My blood tests show that my triglycerides are higher than normal so I was asked to take fish oil supplements. I do a lot of physical activities too. After about 4 months, we have seen a decrease in triglyceride levels, though just a little and still above the reference/range. Point is it seems to be working.

And then I read this article that says omega-3 linked to increased risk of prostate cancer:

The supplement that is helping me battle dyslipidemia (and perhaps future cardiac problems) seems to be putting me at risk of prostate cancer. Is there anything I can do? Maybe continue fish oil supplements, then stop when my triglyceride levels are ok, and then take them again when it goes up (like on-and-off on fish oil capsules as needed)? Perhaps niacin supplements?

I have also read somewhere (I think in The Body or The Body Pro, but I can't recall) that HIV antiretroviral meds have been found to have protective benefits against certain types of cancers. I cannot recall what those cancers are, but I so wish prostate cancer is one.

Response from Dr. Young

Hello and thanks for posting.

To be clear, the reason why we worry about triglycerides and cholesterol is their relationship to cardiovascular disease risks. So before launching into what your need for triglyceride treatments are, note that there are multiple cardiovascular disease risks.

It's therefore relevant to ask about your diet, lifestyle (sedentary or not), family history, etc. Also, note that efavirenz (Sustiva) is also associated with increased triglycerides compared with other third agents (in particular, raltegravir and rilpivirine), so it's conceivable that your medications may be contributing to the modesty high levels.

The recent reports about fish oil supplements and increased risks of prostate cancer are provocative- and certainly if you're at higher risk for prostate cancer (such as family history) are concerning. This reinforces my general MO that the best preventive health strategy isn't a pill or a supplement, but rather, a tobacco-free, exercise-rich and balanced-diet lifestyle.

Perhaps a pragmatic way to look at all of this is to stop your fish oil supplement and see what effect this has on your triglyceride levels.

I hope that helps, BY

choice of treatment for cd4~50, vl 300k
HIV Doctor in Hyderabad

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