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Dyslipidemias pp 155-176 | Cite as

Dyslipidemia in HIV-Infected Patients

  • Frederick J. LeeEmail author
  • Andrew Carr
Chapter
Part of the Contemporary Endocrinology book series (COE)

Abstract

Derangements of lipid metabolism are a common finding in human immunodeficiency virus (HIV) infection, and may lead to increased cardiovascular risk. Untreated HIV infection results in an initial fall of high-density lipoprotein (HDL) cholesterol, followed by declines in non-HDL cholesterol fractions. With progression to the acquired immune deficiency syndrome (AIDS), serum triglyceride levels rise. These changes appear principally driven by inflammation accompanying ongoing viral replication, and correlate with levels of the pro-inflammatory cytokines interferon-α and tumour necrosis factor-α. HIV protein products (nef, tat, gp120) may also exert direct effects on lipid metabolism. dyslipidemias persist despite treatment with antiretroviral therapy (ART). Lipodystrophy associated with thymidine analogue therapy is strongly associated with elevated triglycerides, total and non-HDL cholesterol, and depressed HDL cholesterol. Most ART drugs lead to mixed lipid derangements, but there is considerable variability both between and within the different ART classes in their effects, and do not necessarily equate to increased cardiovascular risk. Protease inhibitors (PI) are the class most associated with dyslipidemia and cardiovascular risk. Newer ART classes (integrase inhibitors, chemokine receptor 5 entry antagonists) have minimal lipid effects, although long-term cardiovascular event data are lacking. Treatment options for dyslipidemia include switching from PI therapy or initiating statin therapy; both are feasible, although it is unknown which is superior. There are no data for the endpoint of risk reduction with treatment, and this is an area requiring further study.

Keywords

Antiretroviral therapy Protease inhibitors HIV Cardiovascular risk dyslipidemia 

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Copyright information

© Humana Press 2015

Authors and Affiliations

  1. 1.Clinical Research Program, St. Vincent’s Centre for Applied Medical ResearchSt. Vincent’s HospitalSydneyAustralia

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