HIV and cholesterol: How HIV meds affect heart health and what to do about it

When you’re managing HIV, a chronic viral infection that weakens the immune system and requires lifelong treatment, your focus is often on keeping the virus under control. But there’s another silent threat that comes with long-term HIV care: cholesterol, a fatty substance in your blood that, when too high, clogs arteries and raises heart attack risk. Many people with HIV don’t realize their meds—while lifesaving—can push cholesterol levels up, especially LDL, the "bad" kind. This isn’t a side effect you can ignore. Heart disease is now one of the top causes of death in people living with HIV, even when the virus is well-managed.

Antiretroviral therapy, the standard treatment for HIV that uses combinations of drugs to suppress the virus is the main driver behind these cholesterol changes. Some drugs, like older protease inhibitors, are known to raise triglycerides and LDL. Even newer regimens can nudge lipid levels higher, especially in people who already have risk factors like being overweight, smoking, or having a family history of heart disease. It’s not just about the drug—it’s about how your body responds over time. Studies show that after just one year on certain HIV meds, LDL can jump by 20% or more. That’s not a small blip. It’s a signal to act.

Here’s the good news: you don’t have to accept high cholesterol as part of living with HIV. You can fight back. Lifestyle changes like walking 30 minutes a day, cutting back on sugar and saturated fats, and quitting smoking can make a real difference. Your doctor can also switch your HIV regimen to a more heart-friendly option—like switching from a protease inhibitor to an integrase inhibitor—without losing virus control. Blood tests for cholesterol aren’t optional; they’re essential. Get them done at least once a year, or more often if your levels are climbing. And if your numbers are still high after lifestyle changes, statins are safe and effective for most people with HIV. You don’t need to choose between controlling HIV and protecting your heart. You can do both.

What follows are real, practical posts that dig into how HIV drugs interact with your body’s chemistry, what alternatives exist, how to talk to your doctor about lipid changes, and what other medications—like beta-blockers or blood thinners—might be involved when heart health becomes a priority. These aren’t theory pieces. They’re based on what patients and doctors are seeing right now. You’ll find answers about drug interactions, what to ask your pharmacist, and how to avoid complications that quietly build up over years. This is the information you need to stay healthy, not just alive.