Management of Lipid Levels and Cardiovascular Disease in HIV-Infected Individuals: Just Give Them a Statin?

Abstract

Current guidelines for managing cholesterol to reduce cardiovascular disease (CVD) risk focus on providing the appropriate intensity of statin therapy to reduce low-density lipoprotein cholesterol (LDL-C) level. There is very little evidence supporting the use of treatments aimed at raising high-density lipoprotein cholesterol level or reducing triglyceride levels. HIV-infected persons have excess risk of CVD compared with the general population. Statins are less effective at reducing LDL-C levels in HIV-infected persons who are also at greater risk for adverse effects from statin treatment. When selecting a statin to achieve desired lowering of LDL-C level, the potential for drug interactions with antiretroviral therapy must be considered. Information from ongoing research is expected to help identify optimal strategies for use of statin treatment in this population. This article summarizes a presentation by James H. Stein, MD, at the IAS-USA continuing education program, Improving the Management of HIV Disease, held in Chicago, Illinois, in May 201.

Conflict of interest statement

Financial affiliations in the past 12 months: Dr Stein has served on data and safety monitoring boards for Lilly and received research grants awarded to his institution from Gilead Sciences, Inc. He has intellectual property rights licensed by the Wisconsin Alumni Research Foundation for carotid ultrasound and CVD risk and receives royalties for a textbook chapter from UptoDate.

Figures

Figure.

Individuals who may benefit from statin therapy and the recommended intensity of their treatment, by group. ASCVD indicates atherosclerotic cardiovascular disease; LDL-C, low-density lipoprotein cholesterol. Adapted from Stone et al.