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Treatment of dyslipidemias in HIV-infected individuals
[print pdf 107kb] Updated 1/11/06
Obtain fasting (9-12 hours) lipid profile prior to starting ARVs, within 3-6 months of starting new regimen, and yearly unless abnormalities are detected or therapeutic interventions are initiated. On average, non-fasting labs falsely elevate TG by 20-30 and falsely lower LDL by 4- 6. Lipid levels may need to be repeated after fasting for more accurate measurements.
II. Determine number of risk factors for CHD (diabetes is a CHD risk equivalent) and refer to Nutrition/Smoking Cessation
III. For pts with ≥ 2 RF estimate 10-year risk of MI or cardiac death - see table on back or online calculator at http://hin.nhlbi.nih.gov/atpiii/calculator.asp
IV. Lipid goals and treatment decisions (Any pt at high or moderately high risk who has lifestyle-related risk factors is a candidate for Therapeutic Lifestyle Changes (TLC) regardless of LDL level)
*CHD risk equivalents: PAD, abdominal aortic aneurysm, symptomatic carotid stenosis, diabetes, and 2+ risk factors with 10-year risk for CHD >20%
Therapeutic Lifestyle Changes (TLC) Features:
Effects of drugs on lipids
When using a statin, obtain LFTs at baseline and at 12 weeks following both the initiation of therapy and dose elevation. Check every 6 months thereafter.
Repeat lipid panel every 6 weeks after the initiation of therapy until LDL goal achieved, then every 4-6 months.
In one study, Protease inhibitor based regimens were associated with fasting TG inc of 50%, TC and LCL inc 10% and no change in HDL-cholesterol compared to non-PI based regimens. Atazanavir has a more favorable effect on all lipid parameters. Stavudine has been variably associated with increases in fasting TG, TC and LDL. Nevirapine has superior lipid profile to efavirenz.
Cannon CP, Intensive versus moderate lipid lowering after acute coronary syndromes, NEJM 2004; 350:1495-504
Heart Protection Study Collaborative Group, MRC/BHF Heart Protective Study of cholesterol lowering with simvastatin, Lancet 2002; 360:7-22.
NCEP Report: Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines Circulation 2004;110:227-239 or http://www.nhlbi.nih.gov/guidelines/cholesterol/
Guidelines for the Evaluation and Management of Dyslipidemia in Human Immunodeficiency Virus (HIV)- Infected Adults Receiving Antiretroviral Therapy: Recommendations of the HIV Medicine Association of the Infectious Disease Society of America and the Adult AIDS Clinical Trials Group CID 2003;37: 613-627.
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