HIV-associated dyslipidaemia: pathogenesis and treatment.

Abstract

Dyslipidaemia, consisting of hypertriglyceridaemia together with depressed concentrations of high-density lipoprotein cholesterol and elevated low-density lipoprotein cholesterol, is being observed with increasing frequency among HIV patients. Pathogenic mechanisms include effects of the virus itself, effects of the antiretroviral drugs on key metabolic pathways, and drug-associated adipose repartitioning with subsequent development of insulin resistance and associated metabolic derangements. Diagnostic methods include a fasting lipoprotein profile and assessment of secondary factors. Treatment strategies include non-pharmacological approaches such as changes to diet and lifestyle, as well as switching to a less metabolically active antiretroviral regimen without compromising antiretroviral efficacy. Pharmacological treatment may include statin drugs, fibrates, niacin, or cholesterol absorption inhibitors, in addition to management of comorbidities such as increased global cardiometabolic risk and insulin resistance.