Dr. Wohl,

Hello I have been on a combo containing several protease inhibitors for a good five years. My lipids are shooting through the roof. I was advised to ask a specialist for a drug that works to lower lipids? Which is your drug of choice, lipitor? Or something else?

Nelson

Hi

It depends what you mean by your "lipids". Most commonly, fasting triglyceride levels go up during PI therapy. Importantly, LDL cholesterol can also rise.

If you have isolated FASTING hypertriglyceridemia (high triglycerides) or if it is your triglycerides that are most elevated a drug called fenofibrate is a commonly prescribed. Omega-3-fatty acids (3-4 grams/day) may also lower triglycerides. Triglycerides are also very responsive to diet. If you can significantly alter your diet to reduce carbohydrates you can help push your levels down.

High LDL cholesterol may require use of a drug in the 'statin' class. These include atorvastatin and pravastatin, two that are safest to use along with PIs. I prefer atorvastatin but this is not a universally held preference.

Your doctor may start with a statin and diet modification and see what happens to both the LDL and triglcyerides, adding fenofibrate if the triglycerides remain high. Regardless, a long talk with a competent nutritionist is essential. Also, if you smoke, stop. DW