ABSTRACT
Management should focus on the adoption of a sensible diet (usually low fat, particularly if the hypertriglyceridaemia is extreme). Other clinical considerations may be pre-eminent in deciding whether to modify the HAART regimen, but ritonavir could be replaced with another protease inhibitor482 or with efavirenz.483 Fibrate therapy may also be tried, and occasionally statin therapy, though liver enzymes must be closely monitored and creatine kinase activities can be difficult to interpret in weight-trainers. It would be unwise to attempt combination therapy with these agents in this type of patient. The specific cause of the hypertriglyceridaemia with protease inhibitors is probably hepatic overproduction of VLDL,481,484 but, as with other secondary hyperlipidaemias, the effect of this is greater in patients predisposed to hyperlipidaemia for genetic and other secondary causes, such as diabetes. Patients who already have decreased triglyceride catabolism because they are heterozygous for a mutation of lipoprotein lipase, or who have the metabolic syndrome or FCH, develop much more marked hyperlipidaemia than they would otherwise do.
