Kaletra and Gemfibrozil (Lopid): A Match Not Made in Lipid Heaven
Here's a heads-up for those of you with HIV and high cholesterol/triglycerides: Depending on which HIV meds you're taking, lipid-busting drugs may not work exactly the way they're supposed to.
The latest item to add to your "Oh Great, Another Thing I Need to Keep an Eye On" list comes from the Journal of Acquired Immune Deficiency Syndromes, and it specifically concerns a drug known as gemfibrozil (brand name: Lopid), part of a family of triglyceride-fighting drugs called fibrates. The study involved eight men and seven women, all of whom were HIV-negative. Here's what happened:
- The 15 people took a single dose of gemfibrozil.
- For the next two weeks, the 15 people took a regular twice-daily dose of Kaletra (lopinavir/ritonavir)
- When the two weeks were up, the 15 people took another dose of gemfibrozil.
- In all 15 people, gemfibrozil didn't absorb into the blood nearly as much as it's supposed to, meaning it lost at least some of its effectiveness.
- Nobody experienced any major side effects.
Unfortunately, this kind of study doesn't actually tell us what to do about this drug-drug interaction. Clearly, gemfibrozil and Kaletra don't work together well. But the researchers didn't specifically recommend a course of action.
Thankfully, we have experts we can turn to for a little perspective. HIV clinician and researcher Ben Young, M.D., Ph.D., offered a word of warning against simply increasing the gemfibrozil dose to make up for the effects of Kaletra. "You can increase the dose of gemfibrozil just so much before you risk unwanted side effects," he told us. "If someone is taking gemfibrozil without effect and they need a fibrate -- and I would double-check the need with a health care provider informed about heart disease risks -- they may want to switch to a different HIV medication."
Young's point is an important one. He is one of a number of physicians who question the value of using lipid-lowering drugs if you only have borderline-high triglycerides (150 to 199) or cholesterol (200 to 239). If you fit in that range, you may want to first do all you can to change your diet or exercise more, perhaps with the help of a nutritionist or a physical trainer if you're able to get one. Many HIV/AIDS advocates also recommend supplements to help lower lipids -- fish oil, for instance. The key is to avoid having to make a rather uncomfortable choice: Is it more important to stick with your lipid drug or your HIV medication?
It's worth noting that this is only the most recent example of a lipid-fighting drug not getting along terribly well with HIV meds. If you hop over to our drug interactions overview section, you'll see a bunch of fact sheets on interactions with each class of HIV meds. A number of cholesterol-fighting drugs known as statins come up frequently on these fact sheets; several statins can alter drug levels of many NNRTIs and protease inhibitors (or vice versa), often requiring some dosing adjustments. Be sure to bring this up when you're talking treatment options with your health care provider.
Despite this gloomy bit of news about how lipid-fighting meds and HIV meds often don't mix, keep in mind that the situation isn't a dire one. If you're taking HIV meds, you do not need to abandon any hope that popping a few extra pills a day can help bring your cholesterol or triglycerides down.
Take it from Michael Silverberg, an HIV researcher with the huge health care organization Kaiser Permanente in California, who did a major review of lipid-lowering drugs in HIVers that was published earlier this year. In an interview with aidsmap.com about the study, Silverberg said, "The good news is lipid-lowering therapy in HIV patients works -- not quite as well as it does in patients without HIV, but close." So stay informed, and work closely with both a knowledgeable HIV specialist and a knowledgeable heart specialist, if possible. That way you'll be in the best position to properly manage your HIV and your lipids at the same time.