HIV-associated and antiretroviral-induced hyperlipidaemia: an update

Antiretroviral-induced hyperlipidaemia is observed frequently and has raised concern about an increase in cardiovascular risk. However, HIV infection itself induces pro-atherogenic lipid changes, which may lead to an increased cardiovascular risk but are partly reversed by some antiretroviral regimens. Recent cohort studies have reported conflicting data on the change in the incidence of cardiovascular disease and the associated risk factors in HIV-positive patients. Switching patients with high low-density lipoprotein-cholesterol or very high triglyceride levels to antiretrovirals with a less pronounced effect on lipids is an option. Patients who are not eligible for this strategy should be considered for treatment with lipid-lowering agents. However, to date, no controlled studies showing a clinical benefit for the treatment of antiretroviral-induced hyperlipidaemia with lipid-lowering agents are available; for patients with several cardiovascular risk factors and pronounced hyperlipidaemia the use of a statin or fibrate is justified. In general, hyperlipidaemia due to antiretroviral therapy should not lead to undertreatment with antiretrovirals or overtreatment with statins or fibrates. Given the overall low number of cardiovascular events, an individualised approach seems adequate.