A 45-year-old man with HIV, who has been on antiretroviral therapy for the past year, comes in for routine follow up. He has been tolerating the antiretroviral therapy well and has no complaints. He is a current cigarette smoker. He used intravenous drugs in the past but is currently not using any illicit drugs. His vitals are normal. His BMI is 26.9kg/m^2. His fasting lipid panel is as follows:
Besides recommending lifestyle modifications, what is the best next step in management of this patient?
The correct answer is:
B) Start pravastatin
ART can cause marked dyslipidemia including: Increased total cholesterol, LDL, and triglycerides (TAG), and reduced high-density lipoprotein (HDL).
Patients with dyslipidemia should have a 10-year cardiovascular risk assessment to determine statin therapy. If 10-year cardiovascular risk of >7.5-10% statins should be started. Most used statins in patients with HIV are rosuvastatin, atorvastatin, and pravastatin. Specific choice is guided to limit drug-drug interaction.
Patients with HIV require ART to prevent disease progression and death, and therefore, should not be discontinued.
Gemfibrozil and omega 3 fatty acids are typically used to treat hypertriglyceridemia.
Nicotinic acid can lower triglyceride level but not to the same degree as fibrate and omega 4 fatty acid medications. A statin is indicated in this case to decrease the cardiovascular risk, not to treat the elevated lab value of triglycerides, though statins can lower the triglycerides also.
