Question of the Week # 115

115) A 44-year-old HIV-infected man with a CD4 count of 280cell/mm3 presents to your office for regular follow up. His viral load is undetectable. His HIV medications include tenofovir, lamivudine and Ritonavir for the past one year.  On examination, he has features of lipodystrophy. A fasting lipid panel reveals Total cholesterol 270 mg%,  LDL cholesterol 200mg%, Triglycerides 150mg% and HDL 40mg%.  He is advised to start low fat diet and exercise. The most important next step in controlling this patient’s hyperlipidemia.

A) Add Niacin

B) Add Simvastatin

C) Add Pravastatin

D) Add Lovastatin

E) Hold HAART therapy until lipids normalize

 

5 Responses

  1. ddddd

  2. E

    • D WITH CAUTION

      • C WITH CAUTION, SORRY

  3. One of the side effects of taking protease inhibitors is increased cholesterol and triglycerides. Therefore, some patients taking HIV protease inhibitors may need to be started on cholesterol lowering drugs, “Statins” . It is important to understand the interaction between Statins and Protease inhibitors so that appropriate statin is chosen to avoid fatal interactions. Protease inhibitors like ritonavir, darunavir, lopinavir inhibit Cytochrome P3A4 enzymes. Most Statins such as Lovastatin, Atorvastatin and Simvastatin are are metabolized by CYP3A4 in the liver. Therefore, strong CYP3A4 inhibitors increase the levels of Statins and produce severe side effects such as myopathy, rhabdomyolysis and hepatitis. Lovastatin and Simvastatin are contraindicated with Protease inhibitors and doses of Atorvastatin/ Rosuvastatin must be reduced. Pravastatin differs from other statins in that it is not extensively metabolized by CYP3A4 and other Cytochrome p450 enzymes. Hence, it has the least potential for drug-drug interactions. Therefore, it is safe to use this concomitantly with protease inhibitors.

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