How is dyslipidemia treated in HIV infection?

Updated: Sep 07, 2018
  • Author: Jason F Okulicz, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Answer

Treatment involves a multimodal approach, incorporating diet changes, exercise, lipid-modifying drug therapy, and, potentially, changes to ART. New lipid management guidelines were released by the American College of Cardiology/American Heart Association [18] in November 2013, which emphasize global risk assessment rather than treat-to-cholesterol targets.

If pharmacologic intervention is indicated for LDL reduction, HMG-CoA reductase inhibitors are the first-line treatment. Note that significant drug interactions occur between most statins and both PIs and NNRTIs. PIs increase serum levels of most statins and increase risk of side effects (eg, rhabdomyolysis). Of all statins, pravastatin is least affected. Atorvastatin, if used, should be started at a low dose and titrated upward. Lovastatin and simvastatin are contraindicated; rosuvastatin and fluvastatin have not been as well studied. Most NNRTIs decrease levels of statins and higher doses may be needed. The other classes of ARVs do not have recognized interactions with statins.

For treating hypertriglyceridemia, fibrates are the first-line drug option.

Other drugs such as niacin can worsen insulin resistance and cause hepatotoxicity; bile acid sequestrants should be avoided because they can interfere with the absorption of other drugs.


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