Side Effects of HIV Medicines

High cholesterol (hyperlipidemia) refers to high levels of total cholesterol in the blood. Cholesterol is a waxy, fat-like substance made by the body and is also found in foods from animal sources, such as egg yolks, meat, and cheese.

Total cholesterol refers to the total amount of low-density lipoprotein (LDL; bad cholesterol) and high-density lipoprotein (HDL; good, protective cholesterol) in the blood. In short, a lot of LDL is a bad thing, but a lot of HDL is a good thing. However, both are still counted when total cholesterol is measured.

While the body needs cholesterol to function properly, too much (specifically LDL) can cause health problems. For example, high cholesterol increases the risk of cardiovascular disease. 

The most common causes of high cholesterol are unhealthy lifestyle habits, including the following:

• Eating foods high in dietary fats, including saturated and trans fats
• Lack of physical activity (sedentary lifestyle)
• Smoking

Other potential risk factors for high cholesterol include:

• Older age
• A family history of high cholesterol
• Other medical conditions, such as diabetes
• Being overweight or obese
• Certain medicines

Some HIV medicines, such as abacavir (ABC) and ritonavir (RTV), may increase the risk of high cholesterol by increasing LDLs, which puts people with HIV at a higher risk of developing hyperlipidemia. In addition, these same medicines may directly increase blood triglycerides, further increasing disease risk.

Usually, high cholesterol has no symptoms. However, a blood test can be used to measure total cholesterol levels.

Cholesterol testing is recommended before and after a person starts taking HIV medicines. If cholesterol levels are normal, testing is recommended once a year. If cholesterol levels are too high, more frequent testing is recommended.

• Eat a healthy diet. Eat foods low in saturated fat, trans fat, and cholesterol. Choose low-fat or fat-free dairy products, eat more high-fiber foods, and eat more vegetables and fruits. Visit Myplate.gov for helpful dietary guidance.
• Get active. Try to get at least 30 minutes of physical activity on most days of the week.
• Maintain a healthy weight. If you are overweight or obese, losing weight can improve cholesterol levels.
• Quit smoking. To find tips and tools to help you quit smoking, visit the Department of Health and Human Services’ Smokefree.gov website.

Treatment for high cholesterol begins with the lifestyle changes outlined above. Sometimes a cholesterol-lowering medicine is also needed—with statins being the most common drug type.

In people with HIV, treatment for high cholesterol may involve changing an HIV treatment regimen to avoid taking HIV medicines that can increase cholesterol levels.

Some HIV medicines can have negative interactions with cholesterol medicines. Health care providers carefully consider potential drug-drug interactions between HIV medicines and any other medicines a person may be taking.

From the NIH Office of AIDS Research: 

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV: 

  • Statin Therapy in People With HIV

  • Adverse Effects of Antiretroviral Agents 

  • Laboratory Testing

From the Centers for Disease Control and Prevention:

• LDL and HDL Cholesterol and Triglycerides

From the Health Resources and Services Administration: 

• Guide for HIV/AIDS Clinical Care: Dyslipidemia 

From MedlinePlus: 

• Cholesterol 

• How to Lower Cholesterol with Diet

From the National Heart, Lung, and Blood Institute (NHLBI): 

• Your Guide to Lowering Your Cholesterol With TLC

Also see the HIV Source for a collection of HIV links and resources.