Lipid Abnormalities in Persons Living With HIV Infection

Publication date: Available online 15 November 2018Source: Canadian Journal of CardiologyAuthor(s): David D. Waters, Priscilla Y. HsueAbstractLipid abnormalities are prevalent among persons living with HIV infection and contribute to increasing the risk of cardiovascular events. Antiretroviral therapy (ART) is associated with lipid abnormalities, most commonly hypertriglyceridemia, but also increases in low-density lipoprotein cholesterol (LDL-C) and total cholesterol. Different classes of ART, and different drugs within classes, have differing effects upon lipid levels, but in general newer drugs have more favorable effects compared to older ones. Low-level inflammation and chronic immune activation act upon lipids through a variety of mechanisms to make them more atherogenic. As a consequence, risk is higher than would be expected for any given cholesterol level. Clinical outcome trials of cholesterol-lowering therapies have not yet been completed in people living with HIV, so that treatment decisions depend on extrapolation from studies in uninfected populations. Traditional risk assessment tools underestimate cardiovascular risk in individuals with HIV. Statins are the mainstay of lipid-lowering drug treatment; however, drug-drug interactions with ART must be considered. Simvastatin and lovastatin are contraindicated in patients taking protease inhibitors, and the dose of atorvastatin and rosuvastatin should be limited to 40 mg and 10 mg/day with some ART combinations. Sw...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research