Background: The use of combination antiretroviral therapy (cART) has significantly decreased
the morbidity and mortality associated with human immunodeficiency virus (HIV) infection.
Lipid disorders, including lipodystrophy, hypertriglyceridemia, and hypercholesterolemia, remain the
most commonly reported metabolic disorders among those treated with long-term cART. Mounting evidence suggests an
association between drug abuse and poor glycemic control and diabetes complications. Substance related disorders (SRD)
may increase the risk of metabolic syndrome.
Materials and Methods: The aim of this retrospective cohort study was to examine the relationship between SRD, cART,
and lipid-lowering agent use in an HIV infected population. Patients received efavirenz or protease inhibitor-based cART
for at least 6 months. Prescription information was retrieved from the medical records. The primary outcome was the use
of lipid-lowering agents including statins, fibrates and fish oil. The impact of SRD and cART was assessed on the lipidlowering
Results: A total of 276 subjects with HIV infection were included, 90 (33%) received lipid-lowering agents, and 31 (34%)
had SRD. Smoking was prevalent among subjects with SRD (84 vs 15%, p<0.001). Statins were the mainstay for the
management of dyslipidemia (66%), followed by the fibrates (24%), omega-3 fatty acids (5%), nicotinic acid (3%) and the
cholesterol absorption inhibitors (3%). Use of statins or fibrates was significantly higher among subjects without SRD
than those with (40 vs 23%, p=0.005). The type of cART, including efavirenz and protease inhibitors, appeared to have no
significant impact on the use pattern of lipid-lowering agents. Lopinavir/ritonavir (lopinavir/r) was mostly prescribed for
subjects with SRD (25 vs 8%, p=0.02).
Conclusion: Among HIV-infected patients, statins remain the mainstay for the management of dyslipidemia in routine
clinical care, followed by fibrates. A significant high risk of metabolic disorders among patients with SRD is implicated
by heavy tobacco use and prevalent lopinavir/r-based treatment. Significantly low rate of lipid-lowering agent use in this
population underscores the importance of lipid disorder scrutiny and cART treatment optimization for HIV-infected patients