[Hypolipidemic therapy under special conditions: acquired immune deficiency syndrome].
Lipid alterations can be observed early among patients with AIDS disease. Commonly, these lipid abnormalities include low HDL-C and modest increase in triglyceride plasma levels. Highly Active Anti-Retroviral Therapy (HAART) in these patients may aggravate the dyslipidemia, with notable increases in triglycerides as well as in LDL-C. There are several mechanisms proposed to explain the mixed hyperlipidemia observed in these subjects, including different steps in lipid metabolism. The importance of the treatment of dyslipidemia became evident with the increased life expectancy and reports of cardiovascular complications in these individuals. There is an insulin resistance state in patients with AIDS disease under treatment with HAART, who present with lipodystrophy, hypertriglyceridemia, low levels of HDL-C. Antiretroviral drugs are metabolized by CYP P450 3A4 and interactions with some statins, especially with simvastatin are expected to occur. Treatment with lipid-lowering agents should be based on lipid profile and coronary risk. For hypertriglyceridemias, fibrates (mainly fenofibrate or bezafibrate) should be the drugs of choice, as well as statins (mainly pravastatin). Combined treatment using fibrates plus statins are recommended for severe mixed hyperlipidemias under very close monitoring for adverse effects.
Yu
Pai Ching
PC
Unidade de Cardiologia, Instituto do Coração, HCFMUSP.
Calderaro
Daniela
D
Lima
Enéas M O
EM
Caramelli
Bruno
B
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000209:etiology; D004347:Drug Interactions; D050171:Dyslipidemias / Q000209:etiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D050356:Lipid Metabolism / Q000187:drug effects
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors