Drugs that lower lipids (fats) in the blood, and are used to treat heart disease and hardening of the arteries, may be prescribed for people with HIV who have high lipid levels.

These drugs are used to treat high lipids or coronary heart disease in people who have not responded to dietary changes. Three classes of drugs may be prescribed to people with HIV.

Statins

Statins are lipid lowering drugs which have been used successfully to lower lipid levels in people on HIV therapy. The statins are less effective than the fibrates in reducing triglycerides, but are effective at reducing LDL cholesterol, and have been shown to reduce cholesterol levels by around 20% in people with HIV.

The drug used most often is pravastatin. This is because some protease inhibitors may cause substantial and potentially dangerous increases in blood levels of statins other

than pravastatin, increasing the risk of muscle damage.

The main side-effect of the statins is inflammation of the muscles. A person taking a statin is advised to report muscle weakness, tenderness or pain to their doctor promptly. The risk of muscle pain and weakness is increased if a statin is taken with certain other drugs such as fibrates (see below), cyclosporin or nicotinic acid. Kidney and liver function should be closely monitored if these drugs are taken

with a statin.

Fibrates

Fibrates are active against elevated triglycerides but they also tend to lower LDL cholesterol and raise HDL cholesterol.

Fibrates include: clofibrate, bezafibrate, ciprofibrate, fenofibrate and gemfibrozil.

These drugs should not be used in people with kidney, gall stone or liver problems, and should not be taken by pregnant women. Side-effects are infrequent but may include: nausea, stomach pain, rash, impotence, dizziness, fatigue and muscle pain.

The fibrates are less likely to interact with protease inhibitors than statins.

Gemfibrozil has been tested in people with HIV, and produced modest triglyceride reductions without significant side-effects.

Fish oils

A fish oil preparation that is rich in omega-3 marine triglycerides can reduce elevated triglycerides but may raise HDL cholesterol levels. It is considered a relatively weak treatment and a large dosage would be needed to reduce the very high triglycerides associated with protease inhibitor therapy, adding between three and ten capsules to the number of pills you would need to take each day.