Diagnostic Tools

Cardiovascular risk assessment

Screening for dyslipidemia/measurement of lipid values

  • Serum lipid levels (total cholesterol, high-density lipoprotein cholesterol (HDL-c), and triglycerides tested after fasting for 8–12 hours) should be determined at HIV diagnosis and before initiation of ARV therapy.2,4
    • If low-density lipoprotein cholesterol (LDL-c) and non-HDL-c are not available from initial blood tests, they can be calculated from the above measurements.4
  • Serum lipid tests should be repeated within 3–6 months after the initiation of ARVs,2,4 then yearly unless abnormalities are detected.
     

Definition of dyslipidemia

  • Due to the wide variation in natural lipid levels, there are currently no predefined ‘cut-off’ values for classifying a patient as having dyslipidemia. Recent trials have used values that correspond to an association with CAD risk:5
    • Total cholesterol: ≥6.2 mmol/L (≥240 mg/dL)
    • HDL-c: ≤0.9 mmol/L (≤35 mg/dL)
    • LDL-c: ≥4.1 mmol/L (≥159 mg/dL)
    • Total cholesterol to HDL-c ratio: ≥6.5
    • Triglyceride level: ≥2.3 mmol/L (≥204 mg/dL)
       

References

  1. Glesby M, Lee D, Armas L, et al. Managing Dyslipidemia in HIV: A Comprehensive Tool for the Primary Care Clinician. 2008. Accessed 09 August 2011.
  2. European AIDS Clinical Society (EACS) Guidelines. Version 6.0. Accessed 3 July 2012.
  3. The Task Force for the management of dyslipidemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). ESC/EAS Guidelines for the Management of Dyslipidemias. Eur Heart J. 2011;32:1769–1818.
  4. Dubé MP, Stein JH, Aberg JA, et al. Guidelines for the Evaluation and Management of Dyslipidemia in Human Immunodeficiency Virus (HIV)–Infected Adults Receiving Antiretroviral Therapy: Recommendations of the HIV Medicine Association of the Infectious Disease Society of America and the Adult AIDS Clinical Trials Group. Clin Infect Dis. 2003;37:613–627.
  5. Fontas E, van Leth F, Sabin CA, et al. Lipid profiles in HIV-infected patients receiving combination antiretroviral therapy: are different antiretroviral drugs associated with different lipid profiles? J Infect Dis. 2004;189:1056–1074.