Novel Insights in the Management of Dyslipidemia in Patients With HIV Infection

Abstract

In recent years, cardiovascular diseases (CVD) have become a leading cause of death in patient with HIV infection, despite a reduction of total mortality in this population. Patients with HIV who are receiving antiretroviral therapy (ART) have approximately 1.5–2 times higher risk for cardiovascular events than HIV-uninfected people. Dyslipidemia is a major risk factor for CVD and is more prevalent in patients with HIV infection. In the present review, we summarize the current concepts in the management of dyslipidemia in patients with HIV infection. Several studies evaluated the safety and effectiveness of statins in the management of dyslipidemia in patients with HIV infections. However, most studies are small and short term and none evaluated the effects of statins on cardiovascular morbidity. There are also very limited data on the role of other lipid-lowering agents in these patients. Moreover, the effect of switching ART on the lipid profile and on viral suppression is also unclear. Management of dyslipidemia in patients with HIV infection is complicated by the increased risk for pharmacokinetic interactions between lipid-lowering agents and ART as well as by the adverse metabolic effects of most classes of ART. However, given the increased cardiovascular risk of this population, lipid-lowering treatment, primarily with statins, should be considered and appears to be equally effective as in non-HIV infected subjects.