Pathophysiology and Clinical Management of Dyslipidemia in People Living with HIV: Sailing through Rough Seas

Area of Science:

• Medical Science
• Pharmacology
• Cardiology

Background:

• Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) pose significant global health challenges.
• Dyslipidemia and increased cardiovascular risk are common complications in people living with HIV (PLHIV), exacerbated by HIV infection and highly active antiretroviral therapy (HAART).

Purpose of the Study:

• To review the multifactorial etiology and pathophysiology of hyperlipidemia in PLHIV.
• To emphasize the role of various HAART agents in lipid disorders.
• To provide insights into HAART switching strategies and therapeutic options for dyslipidemia.

Main Methods:

• Literature review of current research on HIV, HAART, and dyslipidemia.
• Analysis of the impact of different HAART regimens on lipid profiles.
• Evaluation of pharmacotherapies for dyslipidemia in PLHIV.

Main Results:

• Certain HAART agents, including integrase inhibitors, darunavir, atazanavir, tenofovir disoproxil fumarate, nevirapine, and rilpivirine, show favorable lipid profiles.
• Statins are primary treatments for dyslipidemia in PLHIV, but drug-drug interactions with HAART require careful consideration.
• Alternative or add-on therapies like ezetimibe, PCSK9 inhibitors, bempedoic acid, fibrates, or fish oils are options for patients not achieving therapeutic goals or intolerant to statins.

Conclusions:

• Understanding the complex interplay between HIV, HAART, and dyslipidemia is essential for managing cardiovascular risk in PLHIV.
• Selecting HAART regimens with favorable lipid profiles and carefully managing pharmacotherapy for dyslipidemia are key components of comprehensive HIV care.
• Personalized therapeutic strategies, considering drug interactions and patient tolerance, are crucial for optimizing lipid management in PLHIV.