Management of hypercholesterolemia in individuals living with HIV/AIDS

The challenge of managing dyslipidemia in People Living with HIV (PLWHIV) is driven by the high prevalence of Human Immunodeficiency (HIV) and can be due to various coexisting factors such as diabetes, fatty liver, obesity, hypothyroidism, and high alcohol intake. Hyperlipidemia increases the risk of cardiovascular disease in PLWHIV. Importantly, HIV per se is a chronic inflammatory condition that may increase lipid profiles. Unfortunately, different types of antiretroviral therapies (ART) can also contribute to dyslipidemia. The treatment of HIV dyslipidemia is complex and requires a multidisciplinary approach where there is close collaboration between HIV physicians, metabolic medicine physicians, endocrinologists, HIV specialist nurses, and dieticians. Therefore, the HIV Metabolic Clinic must be an integral part of the HIV service. This is important, as management of the interactions between lipid-lowering agents such as statins and ARTs can be handled safely, and initiation of dietary intervention can be monitored by dieticians. In this regard, we have added to this chapter a section about our experience at the HIV Metabolic Clinic in Milton Keynes University Hospital, UK. It is important to note that the current calculators of cardiovascular disease (CVD) risk underestimate CVD risk in PLWHIV, and it is not yet established what is the goal of low-density lipoprotein cholesterol (LDL-C) levels. Future research is needed to establish: (i) whether PLWHIV can be treated with statin regardless of the level of the LDL-C; (ii) what is the best tool to calculate cardiovascular risks in PLWHIV; and (iii) whether the suggested interventions actually decrease morbidity and mortality of this disease.