Metabolic Complications of HIV and Antiretroviral Therapy: Dyslipidemia, Insulin Resistance, and Cardiovascular Disease

  • Authors: Judith S. Currier, MD, MSc; Risa Hoffman, MD, MPH (More Info)
  • Editors in Chief: Joseph J. Eron, Jr., MD; Daniel R. Kuritzkes, MD
  • Last Reviewed: 10/10/18 (What's New)

Summary

    Screening for Dyslipidemia
    • Baseline fasting lipids should be recorded for all HIV-infected patients at entry into care
    • If no lipid abnormalities are present, repeat screening should be performed every 6-12 months, or more frequently if risk factors such as obesity, diabetes, fat redistribution, or a family history of dyslipidemia are present
    Strategic Management of Dyslipidemia
    • ACC/AHA guidelines on management of blood cholesterol recommend moderate- or high-intensity statin therapy in 4 target populations (Table 3) (Management Guidelines)[ACC/AHA 2013]
      Metabolic Syndrome in HIV: Definition, Prevalence, Management
        Treatment and Monitoring of Dyslipidemia
          Role and Limitations of Lifestyle Modifications
            Treatment of Dyslipidemia With Statins
            Treatment of Dyslipidemia With Other Therapeutic Options
              Fibrates
                Other Agents
                  Monitoring Patients Receiving Lipid-Lowering Therapy
                  Treatment of Dyslipidemia by Modifying Antiretroviral Therapy
                    Switching NRTIs
                      Switching to an NNRTI
                        Switching to an Integrase or CCR5 Inhibitor
                          Summary
                          Primary Prevention of Dyslipidemia
                            Considerations for Resource-Limited Settings

                            Action required