British Journal of Nutrition

Full Papers

Human and Clinical Nutrition

Antiretroviral therapy with or without protease inhibitors impairs postprandial TAG hydrolysis in HIV-infected men

Lisa J. Warea1, Akil G. A. Jacksona2, Stephen A. Woottona1 c1, Graham C. Burdgea1, John F. Morlesea2, Graeme J. Moylea2, Alan A. Jacksona1 and Brian G. Gazzarda2

a1 Institute of Human Nutrition, Mailpoint 113, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK

a2 Chelsea and Westminster Hospital, Fulham Road, London SW10 9NH, UK


Mechanisms underlying the lipodystrophy syndrome associated with antiretroviral therapy (ART) for HIV infection are not completely understood. We investigated the effect of ART on blood lipid concentrations in the fasting state and after consumption of a meal containing [1-13C]palmitic acid in HIV-positive men receiving nucleoside reverse transcriptase inhibitors (NRTI, n 7), NRTI combined with protease inhibitors (PI; NRTIPI, n 6), in HIV-positive but therapy-naïve men (noART, n 5) and in HIV-seronegative men (controls, n 6). HIV-positive subjects had higher fasting TAG concentrations and resting energy expenditure than controls. Subjects receiving NRTIPI therapy had higher fasting NEFA concentrations than the other groups. There were no significant differences in postprandial lipid metabolism between noART subjects and controls. NRTI therapy impaired hydrolysis of meal-derived TAG, most evidently when combined with PI (the NRTIPI group). Accumulation of 13C-label in the NEFA fraction was not different between groups. In the NRTIPI group, fasting and postprandial NEFA concentrations were significantly higher than other groups. Postprandial glucose and insulin responses in HIV-positive subjects did not differ from controls. These findings suggest that ART dyslipidaemia is associated with impaired postprandial TAG clearance, which is exacerbated by NRTIPI therapy. If dyslipidaemia is to be minimised in ART, the specific adverse effects of particular combinations during the fed state should be considered.

(Received April 21 2008)

(Revised December 15 2008)

(Accepted March 23 2009)

(Online publication June 01 2009)


c1 Corresponding author: Dr Stephen A. Wootton, fax +44 2380 794945, email


Abbreviations: ART, antiretroviral therapy; AUC, area under the curve; NRTI, nucleoside reverse transcriptase inhibitors; NRTIPI, NRTI combined with protease inhibitors; REE, resting energy expenditure