**4.1.2 Pharmacological therapy**

The pharmacological treatment for dyslipidemia it is performed with HMG-CoA reductase inhibitors, or statins, are the main representatives of pravastatin and atorvastatin groups. They have been used extensively in clinical practice as first-line treatment for hypercholesterolemia in the general population and in HIV-infected patients, promoting reduction of cardiovascular risk in patients without no history of coronary artery disease and of progression of coronary artery stenosis with decrease of cardiovascular events recurrence, working in primary and secondary, respectively (Dube et al., 2003).

In one study, patients with altered levels of total cholesterol (TC) and triglycerides (TG), using pravastatin 20 mg/day occurring 19% decrease in the level of TC and 37% in the level of TG (Baldini et al., 2000). In another study, diet was associated with therapy with pravastatin 40 mg/day in patients with TC levels greater than 240 mg/dL, indicating a 17% decline in the levels of TC and 19% in the level of LDL-C (Moyle, 2001). Therefore, Palacios et al., in 2002, analyzing a group of patients with TC levels greater than 240 mg/dL under atorvastatin 10 mg/day was found a 27% decrease in the level of TC, 41% of TG and 37% in the LDL-C.

Thus, statins are the first choice in the treatment of elevated LDL-C (> 220 mg / dL) and patients with high total cholesterol associated with hypertriglyceridemia (TG between 200 to 500 mg/dL), initial dose may be used 20-40 mg of pravastatin or atorvastatin 10 mg monitoring possible liver toxicity with laboratory tests (Dube et al., 2003). Protease inhibitors and non-nucleoside inhibitors of reverse transcriptase enzyme use in its metabolism the cytochrome P450 pathway (Smith et al., 2001), the same route used by simvastatin, lovastatin and atorvastatin, then the first two are proscribed to patients under antiretroviral therapy and the latter can be used with caution.

Fibrates are used as second choice in the treatment of hypercholesterolemia. In patients with normal TG and elevated LDL-C levels, a slight decrease in LDL-C ranging from 5 to 20% in the studies carried out. Therefore, the therapeutic fibrates use should be reserved for treatment of hypertriglyceridemia (TG> 500 mg/dL) in these patients (Dube et al., 2003).
