Some HIV-positive people at high risk for heart disease are not having their levels of “bad” LDL cholesterol managed as aggressively as treatment guidelines recommend, say the authors of a single-clinic study published in the April 15 issue of Clinical Infectious Diseases.

The National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP-ATP III) sets cholesterol management guidelines, based on published research, to reduce people’s risk of developing heart disease. Guidelines recommend that if a person has high LDL levels, for example, they should first make dietary and exercise changes. If after 12 weeks of lifestyle modifications LDL is not reduced to target levels, medication is recommended to bring LDL to within the desired range.

James Willig, MD, and his colleagues from the University of Alabama at Birmingham (UAB) studied the medical records of people living with HIV who had their LDL cholesterol checked between July 2004 and December 2005 at the UAB clinic. To meet the criteria for analysis, the patients had to have their LDL cholesterol checked at three time points, with their first and second test results showing levels higher than those recommended in the NCEP-ATP III guidelines. Ninety patients met these criteria.

Willig’s team found that 44 percent were not prescribed medications—such as a cholesterol-lowering statin (e.g., Pravachol)—after failing to get their LDL to within the target range after 12 weeks of lifestyle modifications. What’s more, people with other heart disease risk factors, such as family history or smoking, were the least likely to be prescribed medications on top of their recommended lifestyle modifications. People whose other lipid levels, such as triglycerides, were too high, were the most likely to receive treatment intensification.

The authors comment that the percentage of people who did not receive optimal treatment in this study, a dynamic known as “clinical inertia,” is similar to the percentage found in HIV-negative patients. Clinical inertia may have one or several causes, including patient factors like non-adherence or poor health literacy, and physician characteristics such as lack of awareness of treatment guidelines. Willig’s team recommends that further studies should seek to determine which factors contribute most to clinical inertia in treating people with HIV who have high LDL levels.