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fish oil + fenofibrate is a combination therapy investigated for the treatment of severe hypertriglyceridemia, particularly in patients with HIV receiving highly active antiretroviral therapy (HAART). This combination was the subject of a Phase II clinical trial sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) to address patients who did not respond to monotherapy with either agent. Fenofibrate, a fibric acid derivative, acts as a potent agonist of the peroxisome proliferator-activated receptor alpha (PPAR-alpha), which increases the expression of lipoprotein lipase and reduces apolipoprotein C-III, thereby enhancing the clearance of triglyceride-rich particles. Fish oil, containing omega-3 fatty acids such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), complements this by inhibiting diacylglycerol O-acyltransferase (DGAT), reducing hepatic VLDL-triglyceride synthesis, and further promoting triglyceride clearance.
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