Dr Henry,

I have been on ART for 3 years (Truvada and Isentress) and doing fine. I have been undectable since starting the medication and completelty adherent. My CD4 count is constantly above 800 (started medication at a count of about 500). By all counts, doing realy well. My cholesterol counts, however, have been less than stellar. My latest readings are: Total Cholesterol - 626mmol/L LDL - 413mmol/L HDL - 1.01mmol/L Tryglicerides - 2.4mmol/L

My doctor has prescribed Lipitor and I am hesitant to start this treatment. I have no rational excuse for my resistance to taking the meds (more pills/another medical "condition" etc.). I have 3 Questions: In the absence of any current lifestyle reasons for my high cholesterol (other than a family history of heart disease, hypertension and diabetes), is it poossible that the high cholesterol is a direct consequence of the medication I am taking ? If so, would you suggest a different regimen? ( I have no resistance) Do you think Lipitor (or any other statin) is the right prescription for someone with the cholesterol numbers as reflected above?

Thank you for your kind assistance.

Your HIV regimen generally is viewed (and data and experience supports) as a fat/lipid friendly regimen that usually contributes little to cholesterol problems. Atorvastatin is a good choice for a potent statin that likely will improve cholesterol parameters. It seems unlikely that a change in HIV meds would results in significant improvement (most other regimens would likely have a worse effect on lipid levels). Performing a Framingham or other risk assessment may help make decidions about your overall risk for heart disease and whether treatment seems warranted now. KH