Jan 18, 2015
I am a 44yo white male and have successfully managed my HIV for 10 years. I became concerned that my LDL and Total Cholesterol were going higher despite lifestyle (diet & exercise) changes so I went to a cardiologist because Familial hypercholesterolemia runs through both sides of my family. Two years ago my cardiologist tested me for Lipoprotein (a) and Factor V Leiden. I came back positive for both genetic conditions. Furthermore, my LP(a) value was 430. The highest my Cardiologist has ever seen. In addition, I possess the small particle size molecule, which is even more dangerous. Normal LP(a) values are below 30. Discussed my lipid concerns with my ID specialist and we agreed that I should go off the Atripla after 8.5 years and switch to Complera because of links to elevated lipids. In one month my LP(a) value dropped to 275. However after staying stable for 1.5 years my LP(a) has risen to 295. My cardiologist has now put me on 10 mg of Crestor, Baby Aspirin, Coq10 and removed the Niaspan. I know of many friends who are middle aged and HiV + and having heart attacks, strokes, and some have died of massive heart attacks and strokes. Are you aware of any leading specialists that specialize in HIV and Lipids that I may consult with? I feel like a ticking time bomb and I want to consult with a leading specialistsTwo years ago I was diagnosed with Lipoprotein (a) and Factor V Leiden. Although I feel that my Cardiologist had the foresight to test me for the two conditions, however I also feel that he is limited in his knowledge of LP(a)and doesn't feel it's necessary to perform a calcium scan of my carotid and femoral arteries. Sorry for the long winded email, but hope you may be able to provide some insight to this matter. Also, 1 in 5 possess LP(a) and don't even know it exists. Scary.
Response from Dr. Henry
Hard to say whether any other switch in HIV Meds would result in a better cardiac risk profile than Complera since little comparative data with very little cardiac endpoints has been published. Treating lipoprotein a and small particle size molecules specifically has also received little attention. Aggressive use of rosuvastatin seems reasonable under the circumstance sp having a lower threshold for imaging studies is worth considering since HIV may be another risk factor for earlier cardiac disease. KH
DOLUTEGRAVIR+TRUVADA and Lipodistrophy !
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