Mechanisms of Lipid Elevations Associated With the Treatment of Patients With HIV Infection

Peter J. Piliero, MD

In This Article

Future Prospects

Therapeutic lifestyle changes and the use of HMG-CoA reductase inhibitors both have critical roles in the management of dyslipidemia in the PI-treated patient. Both also have limitations. A more direct approach that would avoid the need for the introduction of additional medication or management techniques would be to use a PI that does not significantly alter the lipid profile in the first place. While none of the current agents offers this benefit, the investigational PI atazanavir generally does not result in clinically relevant disturbances in lipid levels in either treatment-naive or -experienced patients and also reverses nelfinavir-induced elevations in TC, LDL cholesterol, and TG levels within the first 12 weeks of therapy.[54,55,56] Furthermore, atazanavir treatment does not trigger insulin resistance.[57,58] When available, this may be an important option for the patient with multiple comorbidities that contribute to CHD or for the patient with uncontrollable dyslipidemia associated with HAART.