HIV: how to manage dyslipidaemia in HIV

Abstract

Background: Dyslipidaemia is a common metabolic condition occurring in people with HIV (PWH), whether treated or untreated with antiretroviral therapy (ART). As people live longer with HIV, ongoing lipid abnormalities may contribute to increased cardiovascular disease risk. This article aims to provide a narrative updated review on the clinical evaluation and management of dyslipidaemia in PWH.

Methods: A PubMed search was performed with Clinical Queries using the key term "HIV dyslipidemia". The search strategy included clinical trials, randomized controlled trials, observational studies and reviews. The search was restricted to the English literature and the population of PWH.

Results: HIV infection causes dysregulation of metabolic processes, including lipid metabolism, thus leading to dyslipidaemia. The main lipid changes seen in untreated HIV infection are elevated triglyceride levels but lower total, LDL and HDL-cholesterol levels. Treatment of HIV infection with ART often leads to a 'return to health' increase in total cholesterol and LDL-cholesterol back towards pre-HIV infection levels. However, specific ART may cause a further increase in triglyceride and cholesterol levels. The treatment of dyslipidaemia is similar in both HIV and non-HIV populations and includes both non-pharmacological and pharmacological options, with a few caveats.

Conclusions: The management of dyslipidaemia is aimed at reducing cardiovascular risk via the utilization of non-pharmacological and pharmacological interventions. Whilst treatment options are similar, awareness of the impact of polypharmacy and drug interactions between ART and lipid-lowering medications in addition to close monitoring for adverse events is key to being successful in managing dyslipidaemia in PWH.

Keywords: HIV; dyslipidaemia; fibrates; hyperlipidaemia; lipids; statins.