Hyperlipidemia is the term used to describe having high amounts of lipids (fats or fat-like substances) such as cholesterol and/or triglycerides in your blood. HIV+ people are at increased risk of getting hyperlipidemia because of HIV disease and HIV drugs (especially certain protease inhibitors).

Cholesterol is a waxy, fat-like substance found in the bodies of humans and animals. The liver makes all the cholesterol needed for the body, and you also get cholesterol from foods. Your body uses cholesterol to build and maintain cells and to make some hormones, so some cholesterol is good.

Triglycerides are fats circulating in your blood. They come from fat in the diet. Also, when you eat sugar, your body may turn it into fat, which raises the triglycerides in your blood.

The main danger of hyperlipidemia is heart disease. If you have too much cholesterol in your blood it can build up in your arteries, forming plaque. This buildup of plaque is called atherosclerosis, and it can slow down or stop blood flow in an artery. This can cause a heart attack or stroke.

Other risk factors for heart diseases include:

• Medicines (including HIV drugs and anabolics)
• Family history
• Little or no exercise
• High fat, high sugar diet
• Age (women over 55, men over 45)
• Obesity
• Diabetes
• Smoking

High triglycerides can also increase your risk of getting pancreatitis.

There are two main kinds of cholesterol. The “good cholesterol” is HDL. Higher amounts of HDL in the blood lower your risk of heart disease. LDL is the “bad cholesterol.” The higher your LDL, the higher your risk of heart disease.

Your doctor can tell you if you have high cholesterol or triglycerides by doing a simple blood test. He or she will measure total cholesterol, HDL, LDL, and triglycerides. (You should be fasting when this test is done.)

• The normal range for total cholesterol in the blood is 100-200 mg/dL. If your total cholesterol is over 200 you have high cholesterol
• The ideal range for HDL cholesterol is greater than 45 mg/dL
• The normal range for LDL cholesterol is 65-129 mg/dL. Your doctor may want this number to be even lower, depending on how many risk factors for heart disease you have
• The normal range for triglycerides in the blood is 10-160 mg/dL

Your body gets cholesterol when you eat foods that contain cholesterol or saturated fat. For the most part, cholesterol and saturated fats are only found in animal products like meat and dairy. Saturated fats are “bad fats.”

Other “bad fats” are hydrogenated fats, or trans-fatty acids. Trans-fatty acids are fats that have been chemically changed so that they act like saturated fats in your body. They are often found in sweets, convenience foods, boxed foods, margarines, salad dressings, fried foods, etc. If the list of ingredients on a food label includes any “hydrogenated” or “partially hydrogenated” fats or oils, that food contains trans-fatty acids.

Simple sugars found in white breads, pasta, sodas, sweets, and fruit drinks can raise triglycerides. It is important to limit the amount of simple sugars in your diet.

“Good fats” are also known as monounsaturated fatty acids, essential fatty acids, or omega-3 or omega-6 fatty acids. These essential fatty acids (EFAs) can help lower your cholesterol, triglycerides, and LDL. EFAs are found in fish, nuts (walnuts and almonds), and seeds (flaxseed). If you use fats in cooking, the two best types to use are canola oil and olive oil.

Increasing fiber in your diet can also help lower cholesterol and triglyceride levels. Fiber is found in whole grain breads, whole grains like oats, barley, and quinoa, oatmeal, fruits, vegetables, cooked beans, and whole grain cereals. A high fiber food should contain more than three grams of fiber per serving according to the food label.

Aerobic, or cardiovascular exercise, is the kind of exercise that will help lower your lipid levels. It has been found to lower cholesterol, triglycerides, LDL, and raise HDL!

Aerobic exercises include fast walking, jogging, swimming, bicycling, and stair climbing. Try to work out at least three times a week for 20-30 minutes.

There are a variety of drugs available to help lower cholesterol and triglycerides. These drugs do have side effects, so your doctor may want to try to lower your numbers with diet and exercise before prescribing a drug. Some lipid-lowering drugs can interact with HIV drugs, so make sure you discuss all your drugs with your doctor before starting anything new.  

If you do take a lipid-lowering drug, it is still important to include a good diet and exercise in your lifestyle to help the drug work its best. Also remember to take the drug consistently.

Try these simple tips for lowering cholesterol and triglycerides and decreasing other risk factors for heart disease:

• Avoid fried foods
• Avoid adding extra fats like butter, sour cream, dressings, and gravies to foods
• Limit sweets and boxed snack foods
• Cut excess fat and skin off of meats
• Choose skim milk instead of whole, and try low fat yogurt
• Limit cheese or try low fat cheeses
• Choose whole grain breads instead of white breads
• Increase fiber with whole grains, fruits and vegetables, and cooked beans
• Eat fish three to four times a week
• Increase aerobic exercise to three or four times a week for 30 minutes or more
• Try an essential fatty acid supplement like fish oil capsules or flaxseed
• If your doctor has prescribed lipid-lowering drugs, make sure to take them consistently
• Try to lose weight if you are overweight
• If you smoke, try to quit or at least cut down
• Talk to your doctor about switching HIV drugs if a drug you are taking is causing the problem

1		Dube, M. & Fenton, M. (2003). Lipid abnormalities. Clinical Infectious Diseases 36(2). S79-S83.
2		Geletko, S.M. & Zuwallack, A.R. (2001). Treatment of hyperlipidemia in HIV-infected patients. American Journal of Health-System Pharmacy. 58(07). 607-614.
3		Schambelan, M. et. al. (2002). Management of metabolic complications associated with antiretroviral therapy for HIV-1 infection: Recommendations of an International AIDS Society-USA panel. Journal of Acquired Immunodeficiency Syndrome 31. 607-614.