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

Peter J. Piliero, MD

In This Article


The risk of CHD and acute coronary syndromes is a growing concern in patients with PI-associated dyslipidemia. Although the exact mechanism responsible for the marked elevations in TGs and TC is unknown, PIs produce a series of metabolic alterations that could contribute to the etiology. In all probability, the mechanism of the dyslipidemia is multifactorial and may vary between patients. In the absence of mechanistic explanations for the dyslipidemia, clinicians are left to treat the disorder rather than its cause. Current treatment options include therapeutic lifestyle changes, HMG-CoA reductase inhibitors, and fibric acid derivatives. However, lifestyle alterations are usually insufficient to normalize the lipid profile in these patients, and lipid-lowering therapy is accompanied by concerns about potential drug interactions and hepatotoxicity. Therefore, in addition to the educated use of standard lipid-lowering therapies, there is a need to develop safe and effective PIs that are not associated with dyslipidemia.