CLINICAL
- PIs: most cause elevation in total cholesterol (TC), LDL and triglycerides (TG). Highest risk: RTV, TPV/r and LPV/r. Least or no risk: ATV and SQV. TC and LDL increase an average of 30 mg/dL on PIs. TGs may be severely elevated. Usually seen within 2-3 mos of starting PI.
- NRTIs: d4T highest risk for TG and LDL increase. Low or no risk with TDF and ABC. NNRTIs: EFVNVP associated with TG, LDL increase. NNRTIs increase HDL. Increase in TG, TC and LDL less than for PIs.
- High LDL increases risk of coronary artery disease (CAD). Lipid elevation may be part of metabolic syndrome.
- Hx: evaluate for atherosclerotic disease (CAD, CVA, PVD), diabetes, and CAD risk factors.
- CAD risk factors: smoking; age (men >45, women >55); HTN; HDL < 40 (subtract 1 risk factor if HDL >60); family history of premature CAD (male 1st degree relative < 55, female 1st degree relative < 65 ).
- PE: often unrevealing, though may detect vascular disease, xanthomas, xanthelasma, and, in severe hypertriglyceridemia, lipemia retinalis.
- TG >1000-2000: risk for pancreatitis.
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