Lipids

Lipid is a general term for fat. Lipids include various types of cholesterol, phospholipids, and triglycerides and are carried in the blood as lipoproteins. A lipid profile includes testing the blood for cholesterol, HDL-cholesterol (the 'good' kind), LDL-cholesterol, and triglycerides.

In HIV disease, there is a trend of falling cholesterol and rising triglycerides levels as the disease progresses. However, since the introduction of protease inhibitors, both cholesterol and triglyceride levels can become dangerously high. High lipids increase the risk of blood clots, heart disease and heart attack, stroke, and pancreatitis.

Anyone diagnosed with HIV should have a lipid profile done to obtain baseline values. This should be repeated before beginning HAART. A fast of 12 to 14 hours is usually required before the test, which is a blood draw from a vein in the arm.

One recent study showed that individuals with HIV tended to eat a larger amount of dietary fat than did HIV-negative controls. The authors believe that the increase in fat consumption contributes to hypertriglyceridaemia. They hypothesise that metabolic changes produced by both HIV and HIV therapy, lead to energy loss and that increased fat consumption may be an unconscious choice to increase energy. Perhaps also in HIV disease, there may a change in taste or feelings of satiety.¹

On a more optimistic note, a year-long Brazilian study of individuals initiating HAART showed that those who received an intervention of a 20-minute dietary consultation every three months were able to maintain a stable body mass index, waist-to-hip ratio, and mean total cholesterol and LDL-cholesterol levels.²

If triglycerides are high, nutritional counselling may be very helpful, as would be any means taken to lower trans fat consumption. When possible, persons who smoke should quit to lower their risk of coronary heart disease. Exercise can help in maintaining health lipid levels. 

Lipid-lowering drugs have also been given to help lower cholesterol. This certainly helps with the rising levels seen in men in their forties and in women after menopause. Although these drugs are prescribed for treating high lipid levels in HIV infection, their effectiveness has not been fully established.

Irregularities in lipid function tests are a warning sign that various lifestyle factors may need to be evaluated, as should the addition of lipid-lowering drugs.