Hyperlipidemia is a topic covered in the Johns Hopkins HIV Guide.

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CLINICAL

  • Uncontrolled HIV is associated with increased cardiovascular (CV) risk and acute MI. [7] [14]
  • Lipid effects associated with ART [3]
    • PIs: all boosted PIs → ↑LDL, ↑TG, ↑HDL. ATV/r and DRV/r preferred over FPV/r and LPV/r.
    • NRTIs: d4T > ZDV > ABC→ ↑LDL and ↑TG. TDF has lipid-lowering effect. ABC associated with MI in D:A:D and some other observational studies, but other studies have not found an association. DHHS and IAS-USA guidelines recommend avoiding ABC in patients with high CV risk.
    • NNRTIs: EFV → ↑TG, ↑LDL, ↑HDL.
    • INSTIs: EVG/COBI/TDF/FTC → ↑TG, ↑LDL, ↑HDL. DTG > RAL → ↑TG [11]
  • Drug interactions with PIs and COBI preclude use of some statins; others should be initiated at low doses with monitoring for statin side effects. (See Pharmacological Therapy)

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Last updated: February 1, 2015