[Lipid alterations and cardiovascular risk associated with antiretroviral therapy].
Dyslipidemia is common in HIV-infected patients receiving antiretroviral therapy (ART) and it is often associated with the use of specific antiretroviral drugs. The phenotypic profile can include elevated triglycerides or cholesterol alone, or mixed patterns with varying changes in LDL and HDL lipoproteins, which imply different levels of cardiovascular risk. Growing evidence indicates that ART-associated hyperlipidemia accelerates the development of atherosclerosis and coronary heart disease in HIV-infected patients. In recent years, a number of retrospective database reviews and prospective cohort studies have reported a higher incidence of coronary events in patients receiving ART, which seems to be closely related with the presence of dyslipidemia and the duration of exposure to ART. Although the clinical benefit of treating ART-related dyslipidemia remains unproven, most experts recommend a policy of cardiovascular disease prevention and management similar to that used in non-HIV-infected individuals. In addition, the use of antiretrovirals associated with a more favorable lipid profile is considered. Clinical experience with lipid-lowering therapy in HIV-infected patients is still limited, but there is increasing data confirming its efficacy and safety in this setting. Drug interactions should be taken into account when statins are used in patients receiving protease inhibitors.
Masiá-Canuto
Mar
M
Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital General Universitario de Elche, Universidad Miguel Hernández, Alicante, España. marmasia@ya.co
Bernal-Morell
Enrique
E
Gutiérrez-Rodero
Félix
F
D019380:Anti-HIV Agents / Q000009:adverse effects / Q000145:classification / Q000627:therapeutic use; D044966:Anti-Retroviral Agents / Q000009:adverse effects* / Q000145:classification / Q000627:therapeutic use; D050197:Atherosclerosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D015897:Comorbidity; D050171:Dyslipidemias / Q000139:chemically induced* / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology; D017320:HIV Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D024821:Metabolic Syndrome / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors
D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents; D017320:HIV Protease Inhibitors; D000960:Hypolipidemic Agents; D018894:Reverse Transcriptase Inhibitors