High Cholesterol

Cholesterol is a waxy, fat-like substance.  The body uses it to build cells and make hormones. It also helps the body make bile, which helps digest fats. It is also helps the body use fat-soluble vitamins, including vitamins A, D, E and K. It is carried in the blood.

The liver produces cholesterol from stored carbohydrates and fats. Certain foods can also add to the cholesterol in the body. These include meats, egg yolks, shrimp and dairy products. 

When there is too much fat (such as cholesterol or triglycerides) in the blood, it is called hyperlipidemia.  The cholesterol can build up inside the artery walls. This puts a person at greater risk of getting heart disease or pancreatitis.  (Pancreatitis is a swelling of the pancreas).

Some of the drugs used to treat HIV infection can cause an increase in the cholesterol in the blood.

Cholesterol is carried through the body bonded to different kinds of lipoproteins. The best known are low-density lipoproteins and high-density lipoproteins. Triglycerides help transfer energy from food into the cells.

Symptoms

High cholesterol doesn’t cause symptoms that can be felt.  The only way it can be discovered is through a blood test called a lipid profile.

A doctor usually orders a lipid profile when a person starts taking anti-HIV drugs. The test may be repeated every three or four months to see if there are any changes in the cholesterol levels in your blood. 

Causes

Some protease inhibitors can raise blood fat levels.  Older protease inhibitors, such as Norvir®, are more likely to cause hyperlipidemia than many of the newer protease inhibitors, such as Reyataz®.

Sustiva® is a non-protease inhibitor drug that can also raise blood lipid levels.

Risk Factors

Several things raise cholesterol levels. Some can be controlled; some can’t.

Risk factors that can be controlled include:

• Limiting the drinking of alcohol
• Increasing physical activity
• Avoiding too much saturated fat and sugar in food.  (Fat raises cholesterol levels. Sugar and alcohol raise triglyceride levels. Saturated fat is fat that is solid at room temperature such as cheese.)

Other factors that increase the risk of high cholesterol include:

• Birth control pills
• Diabetes
• Family history (genetics)
• Having low thyroid levels
• Preventing High Cholesterol

Prevention

It isn’t always possible to prevent high cholesterol.  This is  especially true if high cholesterol levels run in a person’s family. When anti-HIV drugs cause high cholesterol levels, the benefits of the drugs on HIV is greater than the bad effects of the high cholesterol.

Managing risk factors for high cholesterol as much as possible is helpful to anyone.  This can be done by:

• By eating a healthy balanced diet. This diet would include low-fat meats such as chicken and fish. It should contain very little fat from animal sources such as milk, butter, cheese or fatty meats.  It should focus on lots of vegetables and fruits.
• Getting exercise that raises the heart rate three to five times a week
• Maintaining a healthy weight
• Drinking only a limited amount of alcohol or none at all
• Managing stress levels.  Stress can raise cholesterol levels.

Diagnosis

A high cholesterol level is diagnosed with a blood test, a lipid profile.  This is done after not eating or drinking anything for 12 hours.

A lipid panel measures:

• Total cholesterol.  It’s desirable to have a cholesterol level of 200 milligrams per deciliter (mg/dL) of blood or lower.
• Triglycerides,which are a type of fat that the body uses to store energy.  A high triglyceride level paired with high LDL cholesterol increases the risk of heart disease.  It is desirable to have less than 150 mg/dL.
• High-density lipoprotein (HDL) cholesterol, which helps remove fat from the body. The higher the HDL is the lower the risk of developing heart disease. It is desirable to have an HDL level of more than 60 mg/dL. This level helps protect against heart disease.
• Low-density lipoproteins (LDL) cholesterol, which carries fat to other parts of the body.  The higher LDL levels are, the greater the risk of developing heart disease. It is desirable to have less than 100 mg/dL of LDL.
• Very low density lipoprotein (VLDL) cholesterol, which distributes triglyceride produced by the body.  High levels of VLDL make cholesterol build up in the arteries.  It is desirable to less than 130 mg/dL of VLDL.
• The ratio of total cholesterol to HDL.  It is desirable to have a ratio of 5 to 1 or less. (This means 5 mg/dL of total cholesterol to every 1 mg/dL of HDL.)
• The ratio of LDL to HDL  

Treatment

The first step in lowering cholesterol levels is to make lifestyle changes:

• Avoid or limit the amount of alcohol consumed
• Get regular aerobic exercise. (This is exercise that raises your heart rate.)
• Keep blood pressure under controlLose weight if necessary to reach a normal weight
• Quit smoking
• Switch to a diet low in saturated fats and sugar
• Increase the amount of fiber, especially water soluable fiber, in your diet. (Water soluable fiber gets soft or gummy when it is in water.)  This helps absorb cholesterol and remove it from the body.

If these steps don’t lower cholesterol, it may be necessary to take cholesterol-lowering drugs.

There are several groups of drugs that can do this. Statins are commonly used to lower cholesterol.  They include Zocor® (simvastatin), Mevacor® (lovastatin), Pravachol® (pravastatin) and Lescol® (fluvastatin) and Lipitor® (atorvastatin).

Some anti-HIV drugs raise the amount of some statins in the body.  It is important that a doctor be aware of all the medications that a person with HIV is taking.  It may be necessary to adjust the doses of either the statin or of anti-HIV drugs to get the right balance of good effects with the fewest side effects.

Another type of cholesterol-lower drug group is the fibrates.  These include Lopid (gemfibrozil) and Tricor (fenofibrate). Like statins, they can have side effects. It is important that they be taken as directed by the doctor.

If a person on anti-HIV drugs has severe high cholesterol, it may be necessary to change some of his or her antiretroviral drugs. For example, it may be necessary to switch from protease inhibitors to another class of anti-HIV drugs.  This might mean changing a person’s entire drug regimen.