References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
People living with HIV are more likely to have high cholesterol than the general population. This is partly due to the effects of certain antiretroviral medications, partly due to HIV-related chronic inflammation, and partly because traditional risk factors (smoking, diet) are more common in some HIV-positive populations.
Managing cholesterol is an important part of long-term health with HIV because elevated cholesterol increases the risk of heart disease and stroke, which are already elevated in people with HIV.
How HIV and ART Affect Cholesterol
Some ART drugs are known to raise cholesterol and triglycerides:
- Protease inhibitors (ritonavir-boosted regimens): Most significant effect on lipids
- Efavirenz: Can raise total cholesterol and LDL
- TAF (tenofovir alafenamide): Associated with lipid increases compared to TDF
- Integrase inhibitors: Generally lipid-neutral, though weight gain (which affects lipids) is associated with dolutegravir and bictegravir
HIV itself
Untreated HIV typically causes low total cholesterol but dyslipidaemia (abnormal lipid ratios). Starting ART often “unmasks” the true lipid profile. Chronic inflammation from HIV also promotes atherosclerosis independently of cholesterol levels.
Managing Cholesterol with HIV
- Regular lipid monitoring: Your HIV clinic should check fasting lipids at least annually
- Lifestyle changes: Diet (reduce saturated fat, increase fibre), exercise, weight management, stop smoking
- Statins: If lifestyle changes aren’t sufficient. Important: some statins interact with ART. Pitavastatin and pravastatin have the fewest interactions. Simvastatin is contraindicated with protease inhibitors and cobicistat.
- ART switch: If your current regimen is driving lipid problems, your HIV specialist may consider switching to a more lipid-friendly combination
Read more: HIV and stroke risk | Heart disease and HIV | Diabetes and HIV
Frequently Asked Questions
Can I take statins with my HIV medication?
Yes, but the choice of statin matters. Pitavastatin is the preferred option as it has no interactions with ART. Atorvastatin can be used with caution. Simvastatin must be avoided with protease inhibitors. Your HIV specialist and GP can coordinate the right choice.
Will switching HIV medication lower my cholesterol?
Possibly. Switching from protease inhibitors to integrase inhibitors, or from TAF to TDF-based regimens, can improve lipid profiles. Discuss with your HIV specialist whether a switch is appropriate for your situation.
Related reading
- A to Z of Sex: Sexual Health Terms Explained
- Alcohol and HIV: What You Need to Know
- Anxiety and HIV: Coping and Getting Support
- Are All STIs Curable?
- Blood Problems and HIV: Anaemia, Low Platelets and More
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
