New guidelines for the evaluation and management of dyslipidaemia in HIV patients on HAART (2003)

Recommendations of the HIV Medicine Association of the Infectious Disease Society of America and the Adult AIDS Clinical Trials Group

Dyslipidaemia is a common problem affecting HIV-positive patients receiving antiretroviral therapy. Since publication of preliminary guidelines in 2000, numerous studies have addressed the risk of cardiovascular disease, the mechanisms of dyslipidaemia, drug interactions, and the treatment of lipid disorders in HIV-positive 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 that materially affect the clinical approach to lipid disorders in the general population.

A working group of clinical scientists, consisting of members of the Cardiovascular Subcommittee of the AIDS Clinical Trials Group, updated the preliminary recommendations to assist clinicians in the evaluation and treatment of lipid disorders among HIV-positive adults.

Data regarding the prevalence and incidence of dyslipidaemia and cardiovascular disease in HIV-positive patients, pharmacokinetic profiles for hypolipidaemic agents, and treatment trials of dyslipidaemia in HIV-positive patients were considered. Although the implications of dyslipidaemia in this population are not fully known, preliminary data indicate increased cardiovascular morbidity among HIV-positive individuals, suggesting that measures to reduce cardiovascular risk should be provided.

The expert panel recommends that HIV-positive adults undergo evaluation and treatment on the basis of NCEP ATP III guidelines for dyslipidaemia, with particular attention to potential drug interactions with antiretroviral agents and maintenance of virologic control of HIV infection.

When drugs become necessary, the expert panel recommends as initial therapy pravastatin or atorvastatin for elevated low-density lipoprotein cholesterol levels and gemfibrozil or fenofibrate when triglyceride concentrations exceed 500 mg/dL.

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