LIPID abnormalities in patients infected with human immunodeficiency virus.
OBJECTIVE
To review the types, mechanisms, clinical implications, and management of lipid abnormalities associated with human immunodeficiency virus (HIV) infection and its treatment.


METHODS
Review of the relevant literature using MEDLINE data sources from 1985 to February 2008, endocrinology textbooks, and hand-searching of cross-references from original articles and reviews. Clinical trials, animal studies, in vitro studies, case reports, reviews, and guidelines of major medical associations were included.


RESULTS
Advanced stages of HIV infection are characterized by low plasma levels of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and elevated triglycerides. Antiretroviral agents can exert negative effects on lipids that vary substantially between different drug classes and between individual drugs within each class. Prospective studies suggest that the use of protease inhibitors may be associated with increased risk of myocardial infarction that is mediated in part by dyslipidemia. Target levels of plasma lipids and management of HIV-related dyslipidemia generally follow the same guidelines as in the general population. However, dyslipidemia in this setting is often difficult to control with a single lipid-lowering agent, and potentially serious drug interactions may exist between some statins, such as simvastatin, and protease inhibitors.


CONCLUSIONS
Plasma lipids should be measured in all patients infected with HIV before and 3 to 4 months after starting antiretroviral drugs. Statins are the initial drugs of choice in most patients. The concomitant use of statins and antiretroviral drugs should take into account various interactions between these agents.
Mikhail
Nasser E
NE
Endocrinology Division, Olive View-University of California Los Angeles Medical Center, Sylmar, California 91342, USA. nmikhail@ladhs.org
D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D004347:Drug Interactions; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy; D017320:HIV Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy; D050356:Lipid Metabolism / Q000187:drug effects; D008055:Lipids / Q000097:blood*; D019821:Simvastatin / Q000009:adverse effects / Q000627:therapeutic use
D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents; D017320:HIV Protease Inhibitors; D008055:Lipids; D019821:Simvastatin