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Guidelines recommend measuring lipids when HIV-positive people enter care, before antiretroviral therapy, and regularly after therapy begins. Recent data indicate success with lifestyle changes that can improve lipids and lower cardiovascular risk, including simple dietary steps and an effective online smoking cessation program for people with HIV. When to start drug therapy for dyslipidemia depends on both lipid levels and coronary heart disease risk. Among people with HIV, the main lipid disorder is high triglycerides with low high-density lipoprotein cholesterol (HDL-C). Triglycerides above 500 mg/dL should generally be addressed before abnormal cholesterol levels. Statins aim to lower low-density lipoprotein cholesterol (LDL-C) and may have antiinflammatory benefits in people with HIV. Research confirms that statins lower cardiovascular event risk in the general population. Atorvastatin and rosuvastatin are preferred high-intensity statins. Pitavastatin has a good pharmacokinetic profile, even with HIV protease inhibitors, but it ranks as a low- or moderate-intensity statin. Fibrates, niacin, and omega-3 fatty acids have roles for some dyslipidemic people with HIV. Fibrates and omega-3 fatty acids are the preferred agents for isolated high triglycerides. Treatment of dyslipidemia may not attain atherogenic cholesterol goals in all patients, but there are incremental benefits in lowering non-HDL-C and LDL-C toward target levels., HIV care guidelines recommend close lipid monitoring in people with HIV. Department of Health and Human Services (DHHS) HIV treatment guidelines for adults and adolescents recommend regular fasting lipid measures: [...]