30
Special Populations
Concurrent Conditions
Chart 13. HIV-Infected Persons
Recommendations
Strength Quality
Clinicians should be aware that patients with HIV are at
increased risk for ASCVD. e association between HIV
infection and ASCVD risk is independent of the risk
associated with major established ASCVD risk factors.
A High
A fasting lipid panel should be obtained in all newly
identified HIV-infected patients before and aer starting
ART.
A Moderate
For primary prevention of ASCVD, HIV infection may
be counted as an additional ASCVD risk factor for risk
stratification.
B Moderate
Risk stratification is based on the NLA Recommendations
for the Patient-Centered Management of Dyslipidemia –
Part 1 with initial risk stratification based on the number of
major ASCVD risk factors (with the caveat that the presence
of HIV infection may be counted as an additional risk
factor), the use of risk prediction tools, such as the ATP III
Framingham Risk Score or the ACC/AHA Pooled Cohort
Equations if two risk factors are present, and the use of
other clinical indicators to help inform clinical judgment, if
needed.
B Moderate
e non-HDL-C and LDL-C goals described in the NLA
Part 1 Recommendations should be followed for HIV-
infected patients. Atherogenic cholesterol goals may not be
attainable in all patients, but there is incremental benefit to
lowering non-HDL-C and LDL-C to approach these goal
levels.
B Moderate
Elevated TG ≥500 mg/dL that is refractory to lifestyle
modification or changes in ART (if an option) should
generally be treated with either a fibrate (fenofibrate
preferred) or prescription omega-3 fatty acids. Aer TG is
lowered (<500 mg/dL), non-HDL-C and LDL-C should be
reassessed for appropriate management.
B Moderate
Statin therapy is first-line for elevated LDL-C and
non- HDL-C. However, interactions between statins
and antiretroviral agents and other medications must
be considered prior to initiating lipid-lowering therapy.
e NLA Expert Panel recommends using atorvastatin,
rosuvastatin, or pitavastatin as the generally preferred agents
in HIV-infected patients.
A Moderate
