ω-3 supplementation in HIV-1-infected individuals with unsuppressed viral load: cause for caution?

Dietary n-3 (ω-3) fatty acids, mainly eicosapentaenoic (C20 : 5n-3, EPA) and docosahexaenoic acids (C22 : 6n-3, DHA) are useful to decrease hypertriglyceridemia in HIV-1-infected patients [1]. These fatty acids are readily incorporated in cell membranes, changing the properties of the phospholipid bilayer [2]. Whether this triggers HIV-1 replication and infectivity remains unexplored, as data are limited to clinical trials conducted in patients under antiretroviral therapy (ART) [3–5], thus precluding the evaluation of any potential effect on viral load. To address this issue, we set up an ex-vivo experiment to test HIV-1 infectivity and replication after inducing a range of ω-3 content in CD4+ T cell membranes resembling to those obtained after dietary supplementation with ω-3 fatty acids. Fatty fish and most fish oil capsules contain both EPA and DHA species at different doses, with DHA usually being the most abundant. The issue of whether all ω-3 species are equal regarding their effects remains elusive. To avoid this caveat, we used DHA as supplemental fatty acid because it is the most abundant ω-3 in cell membranes [6].