HIV: how to manage dyslipidaemia in HIV

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Background: Dyslipidaemia is a common metabolic condition occurring in people with HIV (PWH), whether treated or untreated with antiretroviral therapy (ART). As people live longer with HIV, ongoing lipid abnormalities may contribute to increased cardiovascular disease risk. This article aims to provide a narrative updated review on the clinical evaluation and management of dyslipidaemia in PWH.

Methods: A PubMed search was performed with Clinical Queries using the key term “HIV dyslipidemia”. The search strategy included clinical trials, randomized controlled trials, observational studies and reviews. The search was restricted to the English literature and the population of PWH.

Results: HIV infection causes dysregulation of metabolic processes, including lipid metabolism, thus leading to dyslipidaemia. The main lipid changes seen in untreated HIV infection are elevated triglyceride levels but lower total, LDL and HDL-cholesterol levels. Treatment of HIV infection with ART often leads to a ‘return to health’ increase in total cholesterol and LDL-cholesterol back towards pre-HIV infection levels. However, specific ART may cause a further increase in triglyceride and cholesterol levels. The treatment of dyslipidaemia is similar in both HIV and non-HIV populations and includes both non-pharmacological and pharmacological options, with a few caveats.

Conclusions: The management of dyslipidaemia is aimed at reducing cardiovascular risk via the utilization of non-pharmacological and pharmacological interventions. Whilst treatment options are similar, awareness of the impact of polypharmacy and drug interactions between ART and lipid-lowering medications in addition to close monitoring for adverse events is key to being successful in managing dyslipidaemia in PWH.

Keywords: dyslipidaemia, hyperlipidaemia, lipids, fibrates, statins, HIV.

Citation: Lee D. HIV: how to manage dyslipidaemia in HIV. Drugs Context. 2022;11:2021-8-7.

Contributions: DL drafted and reviewed the manuscript. The named author meets the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, takes responsibility for the integrity of the work as a whole and has given his approval for this version to be published.

Disclosure and potential conflicts of interest: DL discloses and confirms that this article has no potential conflicts of interest. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the author is available for download at:

Acknowledgements: None.

Funding declaration: There was no funding associated with the preparation of this article.

Copyright: Copyright © 2022 Lee D. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2022 Lee D. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

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Correspondence: Daniel Lee, University of California, San Diego Owen Clinic, 200 West Arbor Drive, Mail Code 8681, San Diego, CA, USA, Email:

Provenance: Invited; externally peer reviewed.

Submitted: 22 August 2021; Accepted: 18 October 2021; Publication date: 1 March 2022.

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