In This Month’s Issue

One of the 2 feature articles this month in The Aids Reader is a review of the literature on the management of dyslipidemia. In this article, Dr Craig E. Metroka of Columbia University and colleagues focus on the use of fish oil to reduce elevated triglyceride levels, an independent risk factor for cardiovascular disease and a hallmark of antiretroviral-related dyslipidemia.

Fish oil is increasingly used by the general population, including persons living with HIV/AIDS, for a variety of reasons. One reason is the belief that the daily intake of the omega-3 fatty acids in fish oil––docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)––will lower our risk of cardiovascular disease. And there is a growing body of evidence to support this use. In fact, the FDA has recently given approval for a prescription formulation of fish oil for use as an adjunct to diet to reduce very high triglyceride levels (500 mg/dL or higher) in adult patients.

Elevated cholesterol and triglyceride levels are not only associated with HIV disease itself but are also common complications of most currently recommended antiretroviral regimens. In recognition of the impact of lipid abnormalities on persons with HIV/AIDS, recommendations on the management of dyslipidemia in HIV have been issued jointly by the HIV Medicine Association and the AIDS Clinical Trials Group. Their latest guidelines recommend fish oil as an alternative agent for first-line treatment in patients with triglyceride levels above 500 mg/dL. Using alternative agents, such as fish oil, to treat dyslipidemia can avoid the drug-drug interactions and overlapping toxicities seen with lipid-lowering drugs. With the growing concern regarding the development of heart disease in the treated HIV population and increasing investigations into safe alternatives to the management of cardiovascular risk factors, the review of fish oil supplementation for HIV-infected persons by Metroka and colleagues is timely.

The accompanying editorial comment by Dr David Alain Wohl of The University of North Carolina at Chapel Hill puts the management of dyslipidemia in perspective by summarizing the benefits and drawbacks of current therapies. Wohl concludes that supplementation with omega-3 fatty acids appears to be a good alternative to fibrate lipid-lowering therapy because of the compelling safety and efficacy data on fish oil in the literature. Nevertheless, there remain important concerns regarding the use of fish oil, including an, as yet, unknown mechanism of action and the lack of long-term safety data.

The second feature article is Part 2 of the review by Dr Antoine B. Douaihy and colleagues from the University of Pittsburgh and Dr William S. Breitbart from Memorial Sloan-Kettering Cancer Center on the psychiatric aspects of pain in persons living with HIV/AIDS. (Part 1 was published in our June issue.) This second half of their review covers the different mood, anxiety, and substance abuse assessments; barriers to care; and psychiatric treatments in the context of HIV/AIDS-related pain. As the authors rightly point out, there is a tremendous need for health care providers to adequately treat pain in their patients. The importance of managing pain is underscored by the more than 250 clinical trials of chronic pain, listed on the federal government’s clinical trials Web site, that are ongoing or currently enrolling patients.

This issue also contains our “Images in HIV/AIDS” case, with images from Dr Dmitri Iarikov and colleagues of Tufts University, as well as the latest “Policy Watch” from our regular columnist, Dr Kristine M. Gebbie, who reminds us that prejudice stills exists and in ways of which we are not always conscious.

One last note: This issue contains guidelines for preparing and submitting manuscripts and graphics to The AIDS Reader. You should keep in mind that although the journal does consider unsolicited manuscripts for publication, submissions have a much better chance of being accepted if they have been invited. Physician authors who have not been invited to submit should first fax or e-mail a brief abstract or outline for consideration before preparing a manuscript for publication. Nevertheless, submitted papers-invited or not-that closely follow our Guidelines for Authors for format and style usually are given relatively faster review and editorial processing and thus have the best opportunity for more rapid publication.

Until next month, take care and be well.

John Hawes, Editor
john.hawes@cmpmedica.com