The Effects of Dietary Intervention on HIV Dyslipidaemia: A Systematic Review and Meta-Analysis Clare Stradling 1,2 *, Yen-Fu Chen 2 , Tracy Russell 3 , Martin Connock 4 , G. Neil Thomas 5 , Shahrad Taheri 1,2,6 * 1 HIV Metabolic Clinic, Heart of England NHS Foundation Trust, Birmingham, United Kingdom, 2 Birmingham and Black Country NIHR CLAHRC, University of Birmingham, Birmingham, United Kingdom, 3 Dietetic Department, Western General Hospital, Edinburgh, United Kingdom, 4 Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, United Kingdom, 5 School of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, United Kingdom, 6 School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, United Kingdom Abstract Background: Efficacy of dietary intervention for treatment and prevention of HIV-related lipid disturbances has not been well established. Methods: We conducted a systematic search of electronic databases supplemented with manual searches and conference abstracts, without language restriction. All randomised controlled trials (RCTs) with blood lipid outcomes, involving dietary intervention or supplementation for the treatment or prevention of adult HIV dyslipidaemia, versus no or other intervention were included. Two authors using predefined data fields, including study quality indicators, extracted data independently. Results: Eighteen studies (n = 873) met our inclusion criteria. Seven RCTs for omega-3 supplementation (n = 372), and four RCTs for dietary intervention (n = 201) were meta-analysed using random-effects models. Mild statistical heterogeneity was observed. Dietary intervention reduced triglyceride levels by 20?46 mmol/l (95%CI: 20?85 to 20?07 mmol/l) compared to control. Omega-3 supplementation reduced triglyceride levels by 21.12 mmol/l, (95%CI: 21?57 to 20?67 mmol/l) and total cholesterol, 20?36 mmol/l (95%CI: 20?67 to 20?05 mmol/l) compared to placebo/control. Conclusions: Both omega-3 supplementation and dietary intervention reduced triglyceride level, with the latter possibly to a smaller extent. While dietary interventions are beneficial, more stringent dietary approaches may be necessary to fully address lipid disturbances in HIV patients. Trial Registration: PROSPERO 2011:CRD42011001329. Citation: Stradling C, Chen Y-F, Russell T, Connock M, Thomas GN, et al. (2012) The Effects of Dietary Intervention on HIV Dyslipidaemia: A Systematic Review and Meta-Analysis. PLoS ONE 7(6): e38121. doi:10.1371/journal.pone.0038121 Editor: Alan Landay, Rush University, United States of America Received March 2, 2012; Accepted May 1, 2012; Published June 11, 2012 Copyright: ß 2012 Stradling et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: CS, YFC, and ST are supported by the National Institute for Health Research (NIHR) through the Collaborations for Leadership in Applied Health Research and Care for Birmingham and Black Country (CLAHRC-BBC) programme. The views expressed in this publication are not necessarily those of the NIHR, the Department of Health, NHS South Birmingham, University of Birmingham or the CLAHRC-BBC Theme 8 Management/Steering group. CS was supported by a Research Training Award from Developing Research Leadership, Capability and Capacity amongst Nurses, Midwives and Allied Health Professionals in the West Midlands. For the remaining authors none were declared. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: clare.stradling@heartofengland.nhs.uk (CS); S.Taheri@bham.ac.uk (ST) Introduction While survival with HIV has increased dramatically with highly active antiretroviral therapy (ART), affected individuals are experiencing metabolic complications including insulin resistance and dyslipidaemia, that ultimately translate to increased cardio- vascular disease (CVD). Current guidelines recommend dietary intervention as first line treatment for HIV dyslipidaemia, [1,2,3] based on evidence from the general population, where it has been shown to reduce CVD risk and mortality. [4,5] Whether these findings can be extrapolated to the HIV population on ART is unknown. If dietary interventions were effective, CVD risk can be reduced through behaviour modification reducing toxicity and pill burden accompanying lipid-lowering medication (LLM). Narrative reviews have examined the broader management of HIV dyslipidaemia including drug intervention, [6] and the effect of nutritional support and exercise on body composition. [7] Almeida et al examined dietary intervention from observation and intervention studies, concluding that there was little evidence for effectiveness of dietary interventions for HIV dyslipidaemia. [8] We hypothesized that dietary interventions have a beneficial effect on HIV dyslipidaemia and carried out a systematic review and meta-analysis of randomised controlled trials (RCTs) assessing the efficacy of dietary interventions or supplementation for HIV dyslipidaemia. Methods Current guidelines for systematic reviews were followed [9] including protocol registration (PROSPERO 2011:CRD42011001329). PLoS ONE | www.plosone.org 1 June 2012 | Volume 7 | Issue 6 | e38121