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
A: give Niacin b/c statins are assoc. with lipodystrophy in HIV pts
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.
D . pravastatin
pravastatin and fluvastatins can be safely prescribed in HIV pt taking PI, bc those drugs not met by CYp
C