Possible Drug-Induced Severe Hypertriglyceridemia in a Patient Co-Infected with Human Immunodeficiency Virus and Hepatitis C Virus

Lipid-related disturbances are commonly associated with Protease Inhibitor (PI) use; however, PI-sparing Human Immunodeficiency Virus (HIV) regimens are less frequently associated with increased lipids. A 53 year-old African American female, co-infected with Hepatitis C Virus (HCV) and HIV, maintained on a PI-sparing antiretroviral therapy, experienced a significant elevation in triglycerides following the initiation of HCV treatment with peginterferon Alfa-2a 180 mcg subcutaneously weekly, ribavirin 600 mg orally twice daily, and telaprevir 1125 mg orally three times daily. Two weeks after the start of treatment, a lipid panel was drawn with results: triglycerides (1678 mg/dL), high density lipoprotein-cholesterol (27 mg/dL), total cholesterol (257 mg/dL), and low density lipoprotein-cholesterol (not calculated). Fenofibrate 48mg orally daily was initiated 1 week later. After 7 weeks of fibrate therapy, the triglycerides remained elevated (1690 mg/dL). Marked triglyceride reduction (344 mg/dL) was achieved within 4 weeks of rosuvastatin 10 mg orally daily initiation. Based on the Naranjo score of 4, it is possible that the patient's hypertriglyceridemia was drug-induced by peginterferon Alfa-2a. Statin selection is an important component of dyslipidemia management in co-infected HIV and HCV patients with baseline lipid abnormalities.