Background:  Limited information is available on fat and cholesterol intake in HIV-infected patients. Furthermore, the influence of diet on lipid parameters is unknown in this population. Dietary modification of fat intake may be an important metabolic strategy in HIV-infected patients at risk for cardiovascular disease.

Methods:  We evaluated the relationship between macronutrient intake and metabolic parameters in 373 non-wasting, HIV-infected subjects (207 males, 166 females), as well as 164 healthy community controls (82 males, 82 females). HIV⁺ and HIV^– subjects who volunteered for metabolic studies between 1998 and 2005 at Massachusetts General Hospital, Boston, were included. Dietary intake was determined from 4-day food records and diet history. Data were analyzed using fit modeling, controlling for age, race, gender, and for study number as random effect.

Results:  Age (42±7 vs 42±10 years, p = 0.90), race (57.2 vs 62.8% Caucasian, p = 1.0), and gender (55.5 vs 50.0% male, p = 0.99) were not different between HIV and control subjects, respectively; 69% of HIV subjects were receiving protease inhibitors (PI) and 35% of HIV subjects met the criteria for metabolic syndrome compared to 24% of controls (p = 0.0004). Dietary saturated fat and cholesterol intake were significantly increased among HIV⁺ subjects compared to controls (p = 0.04 and p = 0.03, respectively). A significantly greater percentage of HIV-infected subjects were above the U.S. recommended dietary allowances (RDA) for total fat (>30%/day) (77.0% HIV⁺ vs 69.9% controls, p = 0.04), saturated fat (>10%/day) (76.7% HIV⁺ vs 64.1% controls, p = 0.003), and cholesterol (>300 mg/day) (50.3% HIV⁺ vs 40.0% controls, p = 0.02).

HIV⁺ subjects demonstrated higher triglyceride levels (p = 0.0006), lower HDL levels (p <0.0001), higher visceral : subcutaneous abdominal fat ratio (p = 0.0008), higher insulin levels (p = 0.03), and increased waist-to-hip ratios (p <0.0001) compared to controls. Both saturated fat intake (p = 0.02) and cholesterol intake (p = 0.02) were significantly associated with plasma triglyceride levels among the HIV-infected subjects in multivariate regression modeling controlling for PI use, alcohol, total fat intake, and insulin levels.

Conclusions:  Increased intake of saturated fat and cholesterol occurs in HIV⁺ patients with metabolic abnormalities in the current era of HAART. This increase in saturated fat and cholesterol intake contributes to hypertriglyceridemia in this population and should be targeted for dietary modification.