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

Dyslipidemia is a common problem affecting HIV-infected patients receiving antiretroviral therapy. Since publication of preliminary guidelines in 2000 [1], numerous studies have addressed the risk of cardiovascular disease, the mechanisms of dyslipidemia, drug interactions, and the treatment of lipid disorders in HIV-infected patients. In addition, updated recommendations from the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III [ATP III]) have been published [2] that materially affect the clinical approach to lipid disorders in the general population. A working group of clinical scientists, consisting of AIDS Clinical Trials Group, updated the preliminary recommendations to assist clinicians in the evaluation and treatment of lipid disorders among HIV-infected adults. Data regarding the prevalence and incidence of dyslipidemia and cardiovascular disease in HIV-infected patients, pharmacokinetic profiles for hypolipidemic agents, and treatment trials of dyslipidemia in HIV-infected patients were considered. Although the implications of dyslipidemia in this population are not fully known, preliminary data indicate increased cardiovascular morbidity among HIV-infected individuals, suggesting that measures to reduce cardiovascular risk should be provided. We recommend that HIV-infected adults undergo evaluation and treatment on the basis of NCEP ATP III guidelines for dyslipidemia, with particular attention to potential drug interactions with antiretroviral agents and maintenance of virologic control of HIV infection. When drugs become necessary, we recommend as initial therapy pravastatin or atorvastatin for elevated low-density lipoprotein cholesterol levels and gemfibrozil or fenofibrate when triglyceride concentrations exceed 500 mg/dL.