Clinical Management Considerations for Dyslipidemia in HIV–Infected Individuals

Abstract

Dyslipidemia is common in patients with human immunodeficiency virus (HIV) and may result in significant morbidity, including coronary heart disease (CHD). Treatment of dyslipidemia in these patients is generally based on the National Cholesterol Education Program Adult Treatment Panel III goals for individuals without HIV. For individuals with ≥ 2 cardiovascular risk factors, the risk of CHD should be evaluated using the Framingham risk calculator and managed accordingly. Switching to an antiretro viral regimen with a favorable lipid profile should be considered before pharmacologic management if virologic suppression can be maintained. Statins are the first–choice therapy for elevated low–density lipoprotein cholesterol, but in HIV–infected individuals, special consideration must be given to drug–drug interactions, specifically those between protease inhibitors and statins. Management of dyslipidemia in HIV–infected individuals is a challenging but important aspect of chronic disease management. Additional research, specifically related to the role of chronic inflammation, is needed to better define the relationship between HIV infection and cardiovascular disease.

Keywords:

• statins
• Framingham risk
• cardiovascular disease
• protease inhibitor
• comorbidity
• human immunodeficiency virus