All PIs; lower incidence with ATV and DRV
RPV < EFV
Weeks to months after beginning therapy
PIs: ↑LDL-C, TC, and TG
NNRTIs: ↑LDL-C, TC, and HDL-C
NRTIs: ↑LDL-C, TC, and TG
|20%–50% of children receiving ART will have lipoprotein abnormalities.
High-fat, high-cholesterol diet
Lack of exercise
Family history of dyslipidemia or premature CVD
Low-fat diet, exercise, no smoking
Adolescents and adults: Obtain fasting (12-hour) TC, HDL-C, non-HDL-C, LDL-C, and TG before initiating or changing ART, then every 6 months, and thereafter, every 6–12 months.
Children (aged ≥2 years) without lipid abnormalities or additional risk factors: Obtain non-fasting screening lipid profiles before initiating or changing therapy and then, if levels are stable, every 6–12 months. If TG or LDL-C is elevated, obtain fasting blood tests.
Children with lipid abnormalities and/or additional risk factors: Obtain fasting (12-hour) TC, HDL-C, TG, and LDL-C before initiating or changing therapy and every 6 months thereafter (or more often if indicated).
Children receiving lipid-lowering therapy with statins or fibrates: Obtain fasting (12-hour) lipid profiles, LFTs, and CK before initiating lipid therapy and at 4 weeks and 8 weeks after starting lipid therapy. If minimal alterations in AST, ALT, and CK, repeat tests every 3 months. Also repeat tests 4 weeks after increasing doses of antihyperlipidemic agents.
|Counsel lifestyle modification (low-fat diet, exercise, smoking cessation) for adequate trial period (3–6 months).
Switch to a new ART regimen less likely to cause lipid abnormalities.a
Initiate drug therapy promptly in patients with TG ≥500 mg/dL:
Statins such as pravastatin, atorvastatin, or rosuvastatin.b Ezetimibe may be considered in addition to statins.c
Fibrates (gemfibrozil and fenofibrate) and N-3 PUFAs derived from fish oils may be used as alternative agents for adults with ↑TG but are not approved for use in children.
No consensus as to what LDL-C should prompt treatment in children receiving ARVs.d HIV-infected patients are considered to be at moderate risk of CVD. Assessment of additional risk factors should be done in all patients.e
High-risk patients: Goal LDL-C ≤100 mg/dL.
Moderate-risk patients: Goal LDL-C ≤130 mg/dL.
At-risk patients: Goal LDL-C ≤160 mg/dL.