Effectiveness of lipid-lowering therapy in HIV patients.

PURPOSE OF REVIEW: The aim of this article is to analyse the effectiveness of lipid-lowering therapy in HIV-infected patients. RECENT
FINDINGS: Although data on prevention of cardiovascular disease in HIV-infected patients are limited, available evidence suggests that intervention guidelines should be similar to those that are recommended for the general population. The main target of lipid-lowering therapy is LDL cholesterol; therefore statins are the drugs of choice. The efficacy of statins in HIV-infected persons appears to be lower than expected, although adherence to statin therapy has not been well assessed. Statins combining high potency and little clinically meaningful interactions with antiretroviral therapy (pravastatin, fluvastatin, atorvastatin and rosuvastatin) should be preferred as initial therapy, though comparative studies in HIV-infected persons are scarce. A combination of a statin at medium doses with either ezetimibe or a fibrate other than gemfibrozil may result in more satisfactory results than higher doses of statin monotherapy when LDL cholesterol goals are difficult to achieve or there persist elevated triglycerides and low HDL cholesterol, respectively.
SUMMARY: Adequate choice and dosing of lipid-lowering drugs, given as isolated agents or in combination therapy, and care for good drug compliance in HIV-infected patients at moderate or high cardiovascular risk should help maximize their long-term health.