HIV and Dyslipidemia

What is Dyslipidemia?

Dyslipidemia is defined as an abnormal concentration of lipids, such as cholesterol and triglycerides, in the blood. Dyslipidemia disproportionately affects people living with HIV, and it is a major risk factor for cardiovascular disease. Fortunately, dyslipidemia can be reversed through lifestyle modifications and medication adjustments.

Causes of Dyslipidemia in Patients Living With HIV

Dyslipidemia in HIV patients may be a direct result of the virus itself or a side-effect of antiretroviral therapies. When a person is first infected with HIV, their blood concentration of cholesterol decreases while triglyceride level often rises. Some antiretroviral therapies, especially protease inhibitors, have been associated with hyperlipidemia.

In the initial stage, HIV patients usually experience an increase in the triglycerides and LDL-c, also known as “bad cholesterol.” “Good cholesterol,” or HDL-c, seems to be typically unaffected by antiretrovirals. More research is needed to know precisely why people living with HIV are more vulnerable to dyslipidemia.

Screening for Dyslipidemia in Patients Living With HIV

Dyslipidemia is detected through laboratory testing of the patient’s blood. Blood for analysis of lipid levels, including total cholesterol and triglycerides, should be collected after the patient has fasted for 8-12 hours. If possible, lipid levels should be tested soon after HIV diagnosis and before antiretroviral treatment begins. When starting antiretroviral medication, lipid levels should be monitored every 3-6 months. Once lipid levels stabilize, blood analysis should still be conducted once a year or more often if heart abnormalities show up.

Prevention and Treatment of Dyslipidemia in Patients Living With HIV

Lowering levels of LDL-c, or “bad cholesterol,” is the primary goal of lipid-lowering treatment. The European Society of Cardiology has established guidelines for managing dyslipidemia, and they apply to both HIV-positive and HIV-negative patients.

Behavioral recommendations for preventing and controlling dyslipidemia include:

• Reducing cholesterol and saturated fat consumption
• Losing weight
• Increasing aerobic exercise
• Reducing alcohol intake
• Stopping smoking

If lifestyle modifications are ineffective at controlling the lipid levels, doctors may consider changing the patient’s antiretroviral medications. While changing an antiretroviral treatment regimen, patients should be closely monitored for new medicines’ side effects and virological relapse.

If modifying the patient’s antiretroviral treatment does not result in more acceptable lipid levels, providers can consider prescribing lipid-lowering agents; however, some drugs used for controlling lipids adversely interact with anti-HIV medicines. Therefore, careful consideration must be given to the risks of combining the treatments.

The intensity of dyslipidemia prevention measures should be based on the patient’s underlying risks for cardiovascular disease. Tools for assessing a patient’s likelihood of developing cardiovascular disease include the Framingham equation, PROCAM, and the SCORE tool.