Manage dyslipidemia with HIV
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It is common for those with human immunodeficiency virus (HIV) infection to have dyslipidaemia.1 Also, the risk of having cardiovascular disease increases in patients with HIV that have dyslipidaemia1 and are receiving combined antiretroviral therapy.2 Given the prevalence of this condition, what would help is developing an understanding of how dyslipidaemia in patients with HIV is different and how can one manage it.

Demystifying dyslipidaemia

Dyslipidaemia is a disorder associated with lipoprotein metabolism, which includes lipoprotein deficiency or overproduction.3 It manifests the following lipid changes:3

  • Elevation in total cholesterol
  • Increase in the levels of triglycerides
  • Increase in low-density lipoprotein (LDL) concentration
  • Decrease in the high-density lipoprotein (HDL) concentration

Dyslipidaemia in patients with HIV

Dyslipidaemia puts a person at increased cardiovascular risk, but patients with HIV are more prone to it. This maybe because of great changes in body composition, lipid and glucose metabolism.4

Managing dyslipidaemia in patients with HIV

HIV-associated dyslipidaemia is a common medical condition, and it appears that patients would benefit more from clinics that specialize in both lipid disorders and cardiovascular diseases.5 The management of dyslipidaemia in patients with HIV needs to include lifestyle changes with calorie restriction and weight reduction.1 A clinical trial indicated that lipid-lowering therapy can contribute to the successful management of HIV-associated dyslipidaemia.6

Dyslipidaemia in patients with HIV can be managed by:
  • Dietary modification: A diet designed to maintain or reduce weight and improve the lipid profile of patients with HIV can contribute to managing dyslipidaemia . However, it is important to receive diet counselling on choosing appropriate foods and portion sizes as well as cooking techniques. The emphasis should be on adjusting the patient’s total fat intake; reducing saturated fat, trans-fatty acids and cholesterol; and increasing the consumption of soluble fibres.7
  • Lipid-lowering therapies: This type of medical intervention involves the consumption of drugs such as statins, fibrates, omega-3 fatty acid ethyl esters, and niacin, to name a few. Statins lower LDL and triglycerides and increase HDL in the patient’s blood. However, the side effects of this class of drugs should be discussed with the physician. Fibrates lower triglycerides and may increase HDL levels. However, they are not very effective in reducing LDL. Omega-3 fatty acid ethyl esters are derived from fish oil, which help in lowering high triglyceride levels; however, patients with sensitivities to fish and shellfish should avoid its consumption.8

The assessment and reduction of risk of cardiovascular diseases are parts of preventive medical care that is essential for patients with HIV.6 Lifestyle changes, dietary modifications, being physically active, and taking the appropriate medicines should help bring the dyslipidaemia under control.

References:

  1. Husain NE, Ahmed M. Managing dyslipidemia in HIV/AIDS patients: challenges and solutions [Internet]. [cited 2019 Dec 23]. Available from: https://www.dovepress.com/managing-dyslipidemia-in-hivaids-patients-challenges-and-solutions-peer-reviewed-article-HIV.
  2. Sprinz E, Lazzaretti RK, Kuhmmer R, Ribeiro JP. Dyslipidemia in HIV-infected individuals. Braz J Infect Dis. 2010 Nov-Dec;14(6):575-88. DOI: 10.1016/s1413-8670(10)70115-x.
  3. Shenoy C, Shenoy MM, Rao GK. Dyslipidemia in dermatological disorders. N Am J Med Sci. 2015 Oct;7(10):421-8. DOI: 10.4103/1947-2714.168657.
  4. Annals of African Medicine. Prevalence of dyslipidemia among human immunodeficiency virus infected Nigerians [Internet]. [cited 2019 Dec 23]. Available from: http://www.annalsafrmed.org/article.asp?issn=1596-3519;year=2013;volume=12;issue=1;spage=24;epage=28;aulast=Muhammad.
  5. Pearson GJ, Olson KL, Panich NE, Majumdar SR, Tsuyuki RT, Gilchrist DM, et al. Maintenance of improved lipid levels following attendance at a cardiovascular risk reduction clinic: a 10-year experience. Vasc Health Risk Manag. 2008;4(5):1127-35. DOI: 10.2147/vhrm.s3748.
  6. AHA Conference Proceedings. Prevention strategies for cardiovascular disease in HIV-infected patients [Internet]. [updated 2019 Dec 17; cited 2019 Dec 23]. Available from: https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.107.189628.
  7. Lazzaretti RK, Kuhmmer R, Sprinz E, Polanczyk CA, Ribeiro JP. Dietary intervention prevents dyslipidemia associated with highly active antiretroviral therapy in human immunodeficiency virus type 1-infected individuals: a randomized trial. J Am Coll Cardiol. 2012 Mar 13;59(11):979-88. DOI: 10.1016/j.jacc.2011.11.038.
  8. American Heart Association. Cholesterol medications [Internet]. [cited 2019 Dec 23]. Available from: https://www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia/cholesterol-medications.

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