|
Lipid
Abnormality
|
First Choice
|
Second
Choice
(or if additional treatment needed)
|
Comments |
Isolated
high LDL
|
Statin |
Fibrate
|
Start
with low doses and titrate upward, may have increased induced
myopathy
|
Combined
hyperlipidemia
(high chole-sterol and high trigly-cerides)
|
Fibrate
or statin |
If
starting with fibrate, add statin. If starting with statin,
add fibrate |
Combining
statins may increase risk |
| Isolated
hypertri-glyceridemia |
Fibrate |
Statin
|
Combining
statins may increase risk
|
Dube MP et al. Clin
Infect Dis. 2000;31:1216-24.
•
If the patient is only experiencing an isolated high level of LDL
cholesterol, the first choice of drug therapy should be a statin.
Pravastatin 20 mg/day or atorvastatin 10 mg/day is recommended.
Since these patients may have an increased risk for myopathy, the
clinician should start with low doses and then titrate up to achieve
the desired response. Careful monitoring of creatine kinase values
and virologic status should be performed at regular intervals. A
fibrate, in the form of gemfibrozil or fenofibrate, may be added
if patients fail to respond to adequate doses of a statin. They
may also be used as a alternative when statins are not appropriate.1
• A good deal of patients with HIV infection have combined
hyperlipidemia. These individuals can be started on either a fibrate
or a statin. If desired results are not achieved, a second agent
from a different class can then be added. Statins should not be
combined in these patients.
• Those patients with isolated high triglycerides can be initially
treated with a fibrate, followed by a statin if additional treatment
is needed.
Reference:
1. Dube MP, Sprecher D, Henry WK et al. Preliminary guidelines for
the evaluation and management of dyslipidemia in HIV-infected adults
receiving antiretroviral therapy. Recommendations of the adult ACTG
cardiovascular disease focus group. Clin Infect Dis. 2000;31:1216-24.
|
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