HIV, Cholesterol Level and Vitamin Supplements


I am in my 60s and have had an AIDS diagnosis for just over ten years. For a long time my total cholesterol was considered borderline. Now it is consistently in the range of 210-250. I exercise three times a week, have lowered my carb intake, and monitored the fat content of my food. Now my doctor has recommended that I try red yeast rice as a supplement. Friends have recommended using spirulina to bring the numbers down. Online research brings conflicting answers as to the efficacy of these supplements and does not address interaction with HIV meds. For the last 10 years I have been undetectable, currently <20 for the virus. CD4 count bounces around but seems to be rising in general, recently reaching the highest at 650 and 26%.. Since the doctor recommended the red yeast rice supplement, that may be a safe bet. I am not sure about trying the spirulina. The bottom line is that I am trying to avoid having to take one of the major cholesterol drugs. If I can control this naturally, I would prefer to do so. I already take a number of vitamin supplements, including krill oil. Do you have any thoughts on this?


It seems that you have tried very hard to decrease your cholesterol with diet and exercise, but you fail to tell me what your LDL is. You also do not tell me what HIV medications you are taking. Efavirenz and protease inhibitors may increase LDL cholesterol and triglycerides in some patients. Some doctors chose to switch these patients to more lipid friendly drugs like integrase inhibitors so that they do not have to take a statin.

Red Yeast Rice is a rice product fermented by bacteria that contains the drug lovastatin, and is currently the most effective naturally occurring statin. It is able, like most statins, to reduce circulating cholesterol levels.

However, the FDA has actually detected statins added to this supplement:
FDA Warns Consumers to Avoid Red Yeast Rice Products

There are some studies that show good efficacy in lowering LDL (I am not sure if these studies used products like the one in the FDA warning that would have obvious statin-like effects):

These studies support the claim that red yeast rice lowers cholesterol:

A 2008 study compared people with high cholesterol who took fish oil and red yeast rice with people who took a standard dose of simvastatin (Zocor). The red yeast rice contained lovastatin (Mevacor), but at a lower dose than the prescription drug. Cholesterol levels went down in both groups.

One study by UCLA School of Medicine involved 83 people with high cholesterol levels. Those who took red yeast rice over a 12 week period had lower levels of total cholesterol, "bad" LDL cholesterol, and triglycerides (fats in the blood) compared to those taking placebo. "Good" HDL cholesterol levels did not change in either study group.

A study presented to the American Heart Association showed that red yeast rice lowered LDL cholesterol. In the study, 187 people had mild-to-moderately high levels of total cholesterol and LDL cholesterol. The study showed that taking red yeast rice reduced total cholesterol by more than 16%, LDL cholesterol by 21%, and triglycerides by 24%. HDL cholesterol also went up by 14%.

In another 8-week study of 446 people with high cholesterol, those who took red yeast rice had a drop in cholesterol levels compared to those who took placebo. Total cholesterol fell by 22.7%, LDL by 31%, and triglycerides by 34% in the red yeast rice group. HDL cholesterol went up by 20% in the red yeast rice group as well.

Source of study review: University of Maryland Medical Center

Here are some potential interactions (look at potential protease inhibitor ones):
Red Yeast Rice - Drug Interactions

Spirulina has not been shown to reduce LDL cholesterol, by the way.

Krill oil has shown some modest improvements in LDL and triglycerides, so it would probably be a reasonable supplement to use with red yeast rice.

In health,