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HIV and High Cholesterol

Medically Reviewed by Carmelita Swiner, MD on August 03, 2022

Your body needs cholesterol, but too much can lead to problems like heart disease and stroke. If you have HIV, your risk of high cholesterol, or hyperlipidemia, goes up. To lower your chances of heart problems, it’s important to control your cholesterol.

How Are HIV and High Cholesterol Linked?

We need more research to fully understand the ties between HIV and high cholesterol. Experts are only now starting to see how HIV affects older adults -- those who are most likely to have high cholesterol levels. That’s because people who have the disease are living longer thanks to better treatments.

But it turns out that some of those treatments could be to blame for rising cholesterol. HIV medications like antiretroviral therapy (ART) have been linked to higher levels.

Also, when you have HIV, your immune system is always on, fighting the virus. This chronic inflammation is linked to the buildup of plaque (fat, cholesterol, and other things) in your arteries. That’s important because plaque can boost your risk of heart attack, even when your HIV is under control. If you have HIV, your risk of heart disease and stroke is 1.5-2 times higher than in people who don’t have it.

How to Know if You Have High Cholesterol

High cholesterol usually doesn’t have symptoms, so the only way to know if you have it is to get tested. Your doctor can give you a blood test to check your cholesterol level.

The doctor may test your cholesterol before you start HIV medication to get a baseline, then check it after a few months.

If your cholesterol is high, your doctor may suggest lifestyle changes and medication to lower it. They’ll continue to test you often. If your levels are normal, your doctor may schedule follow-up testing once a year.

You may also get a blood glucose test, hemoglobin A1c test, and lipid profile. The doctor will probably note your blood pressure, weight, body mass index, and waist size every year.

How to Treat High Cholesterol

There are ways to get your cholesterol levels down.

Medication

Your doctor may prescribe drugs called statins to get your readings down. Statins lower your cholesterol by blocking the substance your body uses to make it.

Some studies suggest people with HIV who take statins have better lipid profiles and lower risk of death. Statins also have an anti-inflammatory effect, which can help with the ongoing inflammation HIV causes.

Most statins, taken in low doses, are safe and work well for people with HIV. They include atorvastatin, pitavastatin, pravastatin, and rosuvastatin. But some, like lovastatin and simvastatin, are not recommended for people with HIV.

If you have high cholesterol, your doctor may change your ART regimen to avoid certain drugs or drug interactions. Some HIV medications don’t work well with cholesterol-lowering meds. Others may boost your cholesterol.

Lifestyle Changes

These steps can help lower high cholesterol if you already have it and prevent you from getting it if you don’t. They include:

Eat healthy food. Choose things that are low in saturated fat, trans fats, and cholesterol. Eat more high-fiber foods. Choose healthy cooking oils like canola, corn, olive, or soybean. Limit sweets, sugary drinks, and red meat. Try to eat more:

Get regular exercise. Being active helps you manage your cholesterol. Aim for 30 minutes or more on most days.

Maintain a healthy weight. If you’re overweight or obese, try to lose weight. That can lower your cholesterol.

Don’t smoke. If you smoke, now’s the time to quit. Smoking is closely linked to heart problems.

Limit alcohol.Heavy drinking may lead to heart problems. If you drink, try to keep it to one drink a day.

Show Sources

SOURCES:

U.S. Department of Health and Human Services: “Atherosclerosis,” “HIV and High Cholesterol.”

American Heart Association: “As HIV patients live longer, heart disease might be their next challenge,” “Causes of High Cholesterol,” “Healthy Cooking Oils.”

The American Academy of HIV Medicine: “Cardiovascular Disease Screening and Prevention in Older Adults with HIV.”

Mayo Clinic: “Statins: Are these cholesterol-lowering drugs right for you?”

American College of Cardiology: “Evidence-Based Review of Statin Use in Patients With HIV on Antiretroviral Therapy.”

Circulation: “Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV: A Scientific Statement From the American Heart Association.”

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