Print this page    •   Back to Web version of article

Medical News
Response to Newly Prescribed Lipid-Lowering Therapy in Patients With and Without HIV Infection

March 16, 2009

"Antiretroviral agents, particularly protease inhibitors (PIs), may adversely affect lipid levels in patients with HIV infection. However, it is not known whether HIV-associated dyslipidemia is more difficult to treat," the researchers explained. Thus, they conducted a retrospective cohort study to compare the effectiveness and safety of lipid-lowering therapy in patients with and without HIV infection.

In an integrated health care delivery system from 1996 to 2005, 829 patients with HIV and 6,941 patients without HIV who began lipid-lowering therapy for elevated low-density lipoprotein cholesterol or triglyceride levels were studied. Percentage change in lipids within 12 months and adverse liver- and muscle-related clinical and laboratory events were monitored.

Compared with HIV-uninfected patients, those with HIV infection beginning statin therapy had smaller reductions in low-density lipoprotein cholesterol levels (25.6 percent vs. 28.3 percent; P=0.001), which did not vary by antiretroviral therapy class. Patients with HIV beginning gemfibrozil therapy had substantially smaller reductions in triglyceride levels than patients without HIV infection (44.2 percent vs. 59.3 percent; P<0.001), and reductions with gemfibrozil varied by antiretroviral therapy class (44.0 percent [P=.0001] in patients receiving PIs only, 26.4 percent [P<0.001] in patients receiving PIs and nonnucleoside reverse transcriptase inhibitors [NNRTIs], and 60.3 percent [P=0.94] in patients receiving NNRTIs only). Rhabdomyolysis was diagnosed in three HIV-infected patients and in one patient without HIV infection. The researchers observed no clinically recognized cases of myositis or myopathy. While the risk for laboratory adverse events was low (<5 percent), it was increased in patients with HIV infection.

The study had limitations: Laboratory measurements were not uniformly performed according to HIV status, and adequate fasting prior to lipoprotein testing could not be verified. The results may not be completely generalizable to uninsured persons, women or certain racial or ethnic minorities, the authors cautioned.

"Dyslipidemia, particularly hypertriglyceridemia, is more difficult to treat in patients with HIV infection than in the general population," the researchers concluded. "However, patients with HIV infection receiving NNRTI-based antiretroviral therapy and gemfibrozil had triglyceride responses similar to those in patients without HIV infection."

Back to other news for March 2009

Excerpted from:
Annals of Internal Medicine
03.03.2009; Vol. 150; No. 5: P. 301-313; Michael J. Silverberg, Ph.D., M.P.H.; Wendy Leyden, M.P.H.; Leo Hurley, M.P.H.; Alan S. Go, M.D.; Charles P. Quesenberry, Jr., Ph.D.; Daniel Klein, M.D.; Michael A. Horberg, M.D., M.A.S.

This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update. You can find this article online by typing this address into your Web browser:

General Disclaimer: is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, consult your health care provider.