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

 

6 Responses

  1. A: give Niacin b/c statins are assoc. with lipodystrophy in HIV pts

  2. pravstatin is the safest statin coz it is metabolised by glucoronidation not bt cytP450 as other stains…

    here LDL is raised which is more imp than TG …niacin reduces TG and raises HDL in high doses even it reduces LDL but not like statins..

    I will choose pravastatin as it can be safely given.

  3. pravastatin and fluvastatins can be safely prescribed in HIV pt taking PI, bc those drugs not met by CYp

  4. Ans is c

  5. The pt. has low CD4 ct, Lipodystrophy and hyperlipemia thus in order to manage this pt one needs to take all of the above in consideration, having said that, we can’t stop HAART ( low CD4), we can’t start any of the Statins (due to its assoc. with Lipodystrophy), only option for this pt. is to start him on Niacin for his hyperlipemia.

  6. C. Pravastatin: renally metabolized. Do not interfere with Cyt p450. Avoid interaction B/W ritonavir and simvastatin ( hepatic metabolized ).

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