What Are HIV-Associated Lipid Disorders?

People living with HIV experience dyslipidemia (abnormal cholesterol/triglycerides) due to both HIV infection itself and antiretroviral therapy (ART). This increases cardiovascular disease risk.

Causes:

• HIV Infection Itself: Raises triglycerides, lowers HDL ("good cholesterol")
• Antiretroviral Therapy (ART):
  • Older protease inhibitors (PIs): Raise LDL, triglycerides
  • Some integrase inhibitors: Modest LDL increase
  • Newer regimens generally more lipid-friendly
• Lipodystrophy: Fat redistribution from older ART (especially d4T, DDI)

Typical Lipid Pattern:

• High Triglycerides: Common (often >500 mg/dL)
• Low HDL: "Good" cholesterol decreased
• High LDL: Especially with PIs
• Increased CV Risk

Management:

• Optimize ART Regimen: Switch to more lipid-friendly agents if possible
• Lifestyle: Diet, exercise, weight loss, smoking cessation
• Statins (First-Line for High LDL):
  • Atorvastatin, rosuvastatin preferred
  • AVOID simvastatin, lovastatin with PIs (drug interactions)
  • Start low dose, monitor for interactions
• Fibrates (For High Triglycerides): Fenofibrate
• Omega-3 Fatty Acids: High-dose for severe hypertriglyceridemia
• PCSK9 Inhibitors: If statins insufficient/intolerant

Drug Interactions:

• Protease Inhibitors Interact with Many Statins: Use atorvastatin or rosuvastatin at low doses
• Check Drug Interactions: Before starting lipid-lowering therapy