Ways and means to lower lipids

The US Food and Drug Administration (FDA [1]The U.S. Department of Health and Human Services agency responsible for ensuring the safety and effectiveness of all drugs, biologics, vaccines, and medical devices, including those used in the diagnosis, treatment, and prevention of HIV infection, AIDS, and AIDS-related opportunistic infections. The FDA also works with the blood banking industry to safeguard the nation's blood supply. The Australian equivalent is the Therapeutic Goods Administration (TGA).) recently issued a warning to people taking the highest approved dose of simvastatin, a common cholesterol [2]An essential component of cell membranes and nerve fibre insulation, cholesterol is important for the metabolism and transport of fatty acids and the production of hormones and Vitamin D. Cholesterol is manufactured by the liver, and is also present in certain foods. High blood cholesterol levels have been linked to heart disease and may be a side effect of some anti-HIV medications.-lowering medication, that they have an increased risk of muscle injury compared to people taking lower doses of the drug.1

These days, many PLHIV [3]Person (or people) Living with HIV. This term is now preferred over the older PLWHA. experience raised lipid [4]A fat. (cholesterol) levels and many are taking a statin class of drug to counteract the affect. There is also a school of thought that these drugs should be used as a prophylaxis to prevent high cholesterol.

All of the statins have the potential for side effects, with muscle injury being one that is possibly heightened by HIV and its treatments.

Both elevated lipids and muscle damage can progress slowly and undetected andcontribute to other health issues of the kidneys and cardiovascular system. Fatigue is commonly the first and most noticeable symptom.

While ‘taking another pill’ often seems the simplest solution, with this new warning it’s timely to consider the range of measures available to help lower cholesterol.

Supplementing your diet with a good-quality fish oil and an inulin fibre is a good start. There is also growing evidence of the importance of antiinflammatory diets and other guidelines recommended by the Heart Foundation (www.heartfoundation.org.au [5])

If you are on a protease inhibitor-based regimen, you can also discuss with your doctor whether changing to a nonnucleoside-based one (e.g. to nevirapine or efavirenz) is an option for you.

That said, research has shown that using a statin drug (pravastatin or bezafibrate) is significantly more effective in the management of HAARTrelated hyperlipidaemia than switching therapy from a PI to a NNRTI.2

Sometimes, adding another pill is the simplest solution after all.

1. www.thebody.com [6]
2. AIDS. 2005;19(10):1051-1058