**4.2 Hypertriglyceridemia**

432 Dyslipidemia - From Prevention to Treatment

Dyslipidemia in HIV infection is related to a multifactorial framework (Sprinz et al., 2010), so treatment should be done with non-pharmacological and pharmacological measures.

The HIV-infected patients with dyslipidemia they should be screened before using those drugs as therapy, with the implementation of the change of lifestyle of these patients through diet, exercise, tobacco control, diabetes mellitus and hypertension (Dubé et al., 2003). In one study, the diet associated with exercise in 11% reduced cholesterol levels of patients infected with HIV (Henry et al., 1998). In another study showed that diet accompanied by resistance exercise at least three times a week reduced the cholesterol level

The first measure to be taken will always be non-pharmacologic therapy, unless there is urgent need for intervention, as patients at high risk for coronary artery disease (obesity, diabetes, family history of cardiovascular disease) and extremely high levels of LDL-C

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

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

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

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).

recurrence, working in primary and secondary, respectively (Dube et al., 2003).

antiretroviral therapy and the latter can be used with caution.

**4.1 Hypercholesterolemia** 

**4.1.1 Non-pharmacologic therapy** 

by 18% and triglycerides by 25% (Jones et al., 2001).

greater than 220 mg / dL (Dubé et al., 2003).

**4.1.2 Pharmacological therapy** 

the LDL-C.
