for Health Care Providers

Table 3. Suggested Drug Treatments for Lipid Abnormalities

Lipid Abnormality	First Choice	Second Choice	Comments
* See PBM Criteria for Use for Ezetimibe.
Isolated high LDL, non-HDL cholesterol	Statin	Niacin (time-release formulation) Fibrate (reserve for patients intolerant of other agents who have high LDL, low HDL) Ezetimibe (third choice)*	Be aware of possible statin-ARV interactions (see below and Lipid-Lowering Medications); use pravastatin, fluvastatin, rosuvastatin, or atorvastatin for most patients taking PIs Patients taking PIs may have increased risk of myopathy Start with low statin dosages If incomplete response to statin, consider: Increasing statin dosage Switching to more potent statin (rosuvastatin or atorvastatin) Adding niacin (time-release formulation) Adding ezetimibe Bile acid sequestrants in general should be avoided unless there are no other options; may interfere with absorption of ARVs and other medications Ezetimibe should used as monotherapy only for patients unable to tolerate statins who do not respond to other agents Avoid combining statin and fibrate: increased risk of myopathy Triple therapy with statins, niacin, and ezetimibe is not recommended
Isolated high TG	N-3 fatty acid Niacin (time-release formulation) Fibrate		Fibrates are most effective in lowering TG If response is inadequate, add second agent Atorvastatin may lower TG (as well as LDL)
High LDL + high TG	Statin + N-3 fatty acid or niacin (time-release formulation)	Fibrate	Dual therapy likely to be most effective Could start with single agent (eg, niacin) and add second agent if response is inadequate Avoid combination of statin and fibrate: increased risk of myopathy
Isolated low HDL	Niacin (time-release formulation)	Fibrate	Initiate CV exercise

From Dyslipidemia
Primary Care of Veterans with HIV
Office of Clinical Public Health Programs
Veterans Health Administration, 2009