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Heart disease and anti-HIV drugs
The level of fats in your blood (lipids) may rise when you start treatment, particularly with some ritonavir-boosted protease inhibitor-based treatment. Sometimes they rise far above normal levels and need to be treated by changes in diet, exercise or drugs. An increase to a very high level is especially likely if your levels are already quite high.
Protease inhibitors have been shown to increase cholesterol and triglyceride levels, usually within weeks of starting the drug, although the new protease inhibitor, atazanavir (Reyataz), seems less likely to cause lipid increases. Cholesterol levels may increase on efavirenz and nevirapine too, but much of this cholesterol appears to be ‘good’ (HDL) cholesterol.
Should I be concerned?
There is evidence that people taking protease inhibitors may have an increased risk of heart disease.
The following information on monitoring your risk of heart disease and what action you can take should prove useful.
If you have existing heart disease or diabetes, your treatment should be carefully chosen to ensure that it does not increase the risk of further complications.
If you have several of the risk factors listed in the table on page 32/33/34, and your cholesterol level rises as a result of combination therapy, this may increase your long-term risk of heart disease if your cholesterol stays at this level for a number of years. This is why your doctor will suggest treatment to lower your cholesterol levels.
If you do not have any of these risk factors apart from an increase in cholesterol when you start treatment, it is unlikely that a change in cholesterol levels will have a significant impact on your long-term risk of heart disease.
see table Risk factors for heart disease in lipodystrophy PDF File
Vascular disease (e.g. heart attack, stroke) develops, in part, because cholesterol begins to stick to the walls of blood vessels, including those in the heart. Gradually, deposits called plaques build up – these can rupture and cause blood clots, or may narrow the arteries, causing increased blood pressure and eventually, blockage of the artery. This process takes many years and it is unclear if short-term increases in lipid levels on combination therapy will lead to an increased risk of these problems in later life. Your lipid levels should be tested regularly once you start combination therapy, and should be tested before you start treatment to get a baseline for comparison. They should be tested first thing in the morning before breakfast to get the most accurate measure: this will show the absolute minimum level.
Triglyceride levels may also need to be tested after a meal, because they rise very high within an hour or so of eating. Very high levels of the triglycerides may cause pancreatitis, a life-threatening illness.
HIV itself causes high triglyceride levels in advanced disease. Low levels of HDL cholesterol are also a result of HIV infection.
Changes in glucose levels
Changes in the way your body handles sugar (its glucose metabolism) can also occur on protease inhibitor treatment or with substantial body shape changes. The most severe change is the development of diabetes, a serious disorder. This has happened in around 1-4% of people in studies, but less serious changes in sugar levels and sugar metabolism also occur. These changes can cause tiredness, excessive thirst, frequent urination and
poor concentration.