Marianna of Freemantle writes: Dear Dr Louise, I’m just about to commence HIV treatment and — among other tests — I’ve had my cholesterol level measured. It’s quite high, how can I manage it?
Dear Marianne: Cholesterol is produced in the liver and also consumed as part of our diet. The aim is to reduce total cholesterol , limit any risk factors for heart disease and to remain vigilant for signs of cardiovascular disease developing.
So the ideal way to manage this is to look at all the cardiovascular disease risk factors and try and minimise and manage these where possible.
Diet is an important factor in reducing cholesterol levels. This means lowering your intake of saturated and trans fats — particularly animal fats found in meat, butter, cream and cheese. Coconut and palm oils are also high in saturated fats. High levels of trans fats can be found in anything fried and battered, pies, ice cream, biscuits, cakes and crackers.
Try to eat foods that are high in unsaturated fats, instead, such as oily fish, nuts, seeds, legumes, vegetable oils and spreads. Also, eat plenty of fruit, veggies and fibre. Your doctor or a dietician can give you resources with specific guidelines to assist you with your diet plan.
Aiming to maintain a healthy body weight is important, as carrying even a few extra kilos contributes to high cholesterol . Losing just five to 10 percent of body weight can greatly improve cholesterol levels. Regular exercise will also keep cholesterol in check. You don’t have to go crazy at the gym: a brisk walk, gardening, cycling or dancing will do — anything that raises the heart rate and breaks you out in a sweat. Regular, moderate physical exercise also helps raise high-density lipoprotein — ‘good’ cholesterol .
After a trial of healthy diet and increased exercise, the lipid tests can be repeated to see if there has been any significant improvement in levels. If cholesterol levels remain elevated, and taking into consideration other cardiovascular risks, sometimes lipid -lowering medications — such as statins — are required. They’re usually well tolerated and your doctor will check to ensure there are no interactions with your HIV medications.
Some HIV antiretroviral medications can lead to small increases in lipid measurements. This is usually managed, however, with a healthy diet and the addition of statin medications. Sometimes, the HIV medication regimen may be changed to try and improve things, but this is usually considered along with other factors — such as reducing the number of tablets or perhaps switching to a once-a-day regimen if that is suitable.