ART and statins: What you need to know about heart health and cholesterol meds

When someone is on ART, antiretroviral therapy used to treat HIV by suppressing the virus and preserving immune function. Also known as antiretroviral drugs, it helps people with HIV live longer, healthier lives. Many also take statins, cholesterol-lowering medications that reduce LDL (bad) cholesterol and lower the risk of heart attack and stroke. Common examples include pravastatin, atorvastatin, and rosuvastatin. This combination isn’t unusual—people with HIV often have higher heart disease risk due to chronic inflammation, side effects from long-term ART, and lifestyle factors. But mixing these two types of drugs isn’t always simple. Some statins can build up in the body when taken with certain ART drugs, increasing the chance of muscle damage, liver stress, or even rare but serious side effects like rhabdomyolysis.

The key is knowing which statins play nice with which ART drugs. For example, pravastatin and rosuvastatin are often preferred because they’re less likely to interact with common HIV medications like protease inhibitors. On the other hand, simvastatin and lovastatin are usually avoided because they’re broken down by the same liver enzyme (CYP3A4) that many ART drugs block, leading to dangerous spikes in statin levels. It’s not just about picking the right drug—it’s about monitoring. Regular blood tests for liver enzymes and muscle damage markers like CK are standard practice. And it’s not just the meds—diet, alcohol, age, and kidney function all play a role in how your body handles this combo. If you’re on both, your pharmacist and doctor should be talking to each other. Most people don’t realize pharmacists are trained to catch these interactions before they happen.

What you’ll find in the posts below is real, practical advice from people who’ve been there. You’ll see how pravastatin is often the go-to statin for older adults on ART, why some cholesterol meds cause more muscle pain than others, and how drug labels can warn you about hidden risks. There’s no guesswork here—just clear facts on what works, what to avoid, and how to stay safe without giving up the meds that keep you alive.