Dyslipidaemia

Key considerations for people living with HIV

Dyslipidemia is an important and potentially reversible risk factor for cardiovascular disease (CVD) that has been associated with HIV infection and its treatment.¹ 


Dyslipidemia due to HIV infection and ARV treatment

• Substantial decreases in serum levels of total cholesterol, high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), and increases in triglycerides are observed following HIV infection.^2–4 


• ARV therapy, especially protease inhibitor (PI)-based treatment, is associated with hyperlipidemia^5–7
  • Initiation of HAART has frequently been shown to increase LDL-c and triglycerides,4 but with little change in HDL-c.²
• Refer to the causes section for more information

Rationale for treatment⁸

• High LDL-c levels increase the risk of CVD.
• Low HDL-c levels increase the risk of CVD.

Please also refer to the information on screening for dyslipidemia in the diagnostic tools section. 



Prevention and treatment

Recommendations for managing dyslipidemia in people living with HIV are based on those available for the general population: NCEP ATP III Guidelines⁹ and ESC/EAS Guidelines for the Management of Dyslipidemias.⁴ 

HIV-specific guidelines^8,10 recommend that diet, exercise, maintaining normal body weight and stopping smoking should generally be instituted first and can improve dyslipidemia.

• If lifestyle modifications are not effective, clinicians should consider changes to ARV therapy and then consider lipid-lowering medication in high-risk patients.⁸
• For more information please refer to the section on treatment.
• Particular attention needs to be paid to potential drug-drug interactions.



References

1. Tungsiripat M, Aberg JA. Dyslipidemia in HIV patients. Cleve Clin J Med. 2005;72:1113–1120.
2. Riddler SA, Smit E, Cole SR, et al. Impact of HIV infection and HAART on serum lipids in men. JAMA. 2003;289:2978–2982.
3. Hellerstein MK, Grunfeld C, Wu K, et al. Increased de novo hepatic lipogenesis in human immunodeficiency virus infection. J Clin Endocrinol Metab. 1993;76:559–565.
4. 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.
5. Carr A, Samaras K, Burton S, et al. A syndrome of peripheral lipodystrophy, hyperlipidemia and insulin resistance in patients receiving HIV protease inhibitors. AIDS. 1998;12:F51–58.
6. Périard D, Telenti A, Sudre P, et al. Atherogenic dyslipidaemia in HIV-infected individuals treated with protease inhibitors. The Swiss HIV Cohort Study. Circulation. 1999;100:700–705.
7. Mulligan K, Grunfeld C, Tai VW, et al. Hyperlipidemia and insulin resistance are induced by protease inhibitors independent of changes in body composition in patients with HIV infection. J Acquir Immune Defic Syndr. 2000;23:35–43.
8. European AIDS Clinical Society (EACS) Guidelines. Version 6.0. Accessed 3 July 2012.
9. National Institutes of Health, National Heart, Lung and Blood Institute. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III [ATP III]). Accessed 05 August 2011.
10. 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.