Managing dyslipidemia in HIV/AIDS patients: challenges and solutions

Abstract

Human immunodeficiency virus (HIV) is a chronic disease associated with dyslipidemia and insulin resistance. In addition, the administration of combination antiretroviral therapy is associated with an increase in the incidence of metabolic risk factors (insulin resistance, lipoatrophy, dyslipidemia, and abnormalities of fat distribution in HIV patients). HIV dyslipidemia is a common problem, and associated with an increase in incidence of cardiovascular disease. Further challenges in the management of HIV dyslipidemia are the presence of diabetes and metabolic syndrome, nonalcoholic fatty liver disease, hypothyroidism, chronic kidney disease, the risk of diabetes associated with statin administration, age and ethnicity, and early menopause in females. Dyslipidemia in patients with HIV is different from the normal population, due to the fact that HIV increases insulin resistance and HIV treatment not only may induce dyslipidemia but also may interact with lipid-lowering medication. The use of all statins (apart from simvastatin and lovastatin) is safe and effective in HIV dyslipidemia, and the addition of ezetimibe, fenofibrate, fish oil, and niacin can be used in statin-unresponsive HIV dyslipidemia. The management of dyslipidemia and cardiovascular disease risks associated with HIV is complex, and a certain number of patients may require management in specialist clinics run by specialist physicians in lipid disorders. Future research is needed to address best strategies in the management of hyperlipidemia with HIV infection.

Keywords: HIV; cardiovascular disease; dylipidaemia; fatty liver; insulin resistance; lipid lowering medication.

Figure 1

Illustration of different potential factors that lead hyperlipidemia with HIV and associated increase in risk of CVD. Abbreviations: HIV, human immunodeficiency virus; CVD, cardiovascular disease; CKD, chronic kidney disease; NAFLD, nonalcoholic fatty liver disease.

Figure 2

Illustration showing possible summary of current guidelines for the management of HIV dyslipidemia. Aging populations will need special consideration with regard to adjustment for lipid-lowering medication. Abbreviations: HIV, human immunodeficiency virus; TFT, thyroid-function test; CK, creatine kinase; LFT, liver-function test; NAFLD, nonalcoholic fatty liver disease; US, ultrasonography; TG, triglyceride; TC, total cholesterol; LDL, low-density lipid; LH, luteinizing hormone; FSH, follicle-stimulating hormone.