High Cholesterol and Triglycerides in HIV Infection

People living with HIV commonly have elevated cholesterol and triglycerides levels, which is caused not only by the virus itself but by the very drugs meant to treat the disease. Other factors may also contribute to these conditions, known, respectively, as hypercholesterolemia and hypertriglyceridemia.

What Is Cholesterol?

Cholesterol is defined by the American Heart Association as a waxy substance in a person's bloodstream that is derived from both a person's liver and certain foods—especially red meats and full-fat dairy products.

Excessive cholesterol can block arteries in the body, which prevent adequate blood flow from reaching vital organs, include the heart and brain. This may increase a person's risk of having a heart attack or stroke.

There are two types of cholesterol:

• LDL cholesterol: considered the "bad" cholesterol, high LDL is linked to a higher risk of heart attack and stroke. A diet rich in saturated and trans fats—like red meat, processed foods, and snacks— help raise LDL cholesterol.
• HDL cholesterol: often referred to as "good" cholesterol, low HDL is associated with increased risk of heart attack or stroke. A person's genetics, having type 2 diabetes, smoking, and having a sedentary lifestyle lowers HDL cholesterol levels.

Total cholesterol is calculated by adding the HDL + LDL + 20% of a person's triglyceride level. Generally speaking, a desirable total cholesterol level is less than 200 milligrams per deciliter (mg/dL). 

What Are Triglycerides?

Triglycerides are common fats that either come from foods or are manufactured by the body from the breakdown of carbohydrates. After a person eats a meal, the extra calories not used for immediate energy are converted into triglycerides. These compounds then move through the bloodstream until they reach fat tissue, where they are stored for later use.

Elevated triglyceride levels are linked to an increased chance of having high blood pressure and type 2 diabetes. Moreover, if a person has high triglycerides and either a high LDL level or low HDL, then he or she will be at high risk of heart attacks or strokes.

By and large, a normal triglyceride level is defined as having less than 150 milligrams per deciliter (mg/dL), while a high triglyceride level defined as 500mg/dL or more.

The factors that increase a person's risk of hypertriglyceridemia include:

• Obesity
• Physical inactivity
• Excessive alcohol intake
• Cigarette smoking
• Diets rich in carbohydrates (like sugary snacks, cookies, bread, and potatoes)
• Certain medical conditions like type 2 diabetes or chronic kidney disease
• Certain medications (like antiretrovirals, estrogen, and corticosteroids)
• A person's genetic makeup

Cholesterol and Triglycerides and Their Link to HIV

HIV infection itself causes increased cholesterol and triglyceride levels in infected individual. This condition can be further exacerbated by a person's HIV antiretroviral drugs, which can also negatively impact a person's cholesterol levels.​

HIV drugs classified as protease inhibitors (PIs) are commonly linked to both hypertriglyceridemia and hypercholesterolemia. A number of nucleoside reverse transcriptase inhibitor (NRTI)-class drugs can also contribute to this. Among them:

• Ziagen (abacavir)
• Zerit (stavudine)
• Retrovir (zidovudine, AZT)
• Kaletra (lopinavir + ritonavir)

Management of High Cholesterol and Triglycerides

Due to the cause-and-effect association between HIV and elevated cholesterol/triglycerides, people with HIV should undergo regular blood tests to monitor their serum blood levels.

Lifestyle changes (including exercise, a reduced-fat diet, and smoking cessation) can often mitigate many of ill effects of treatment and infection. In many cases, the use of statin drugs and other medication to reduce cholesterol and triglycerides may be recommended if levels fall out of what might be considered healthy, particularly for older individuals or those with metabolic syndrome.

Research from Kaiser Permanente Division of Research has shown that cholesterol medications can work well among certain people with HIV who are at risk for cardiovascular disease. Though the risk of disease is higher due to lipid abnormalities that can occur with certain antiretroviral drugs, anti-cholesterol medications appear to work very well controlling high or deranged levels.

In addition to traditional statin drugs, the use of lipid-regulating agents like Lopid (gemfibrozil) have been shown to better control both cholesterol and triglyceride levels in people living with HIV.