title: Cardiovascular implications of HIV-induced dyslipidemia.
abstract: Cardiovascular disease (CVD) is currently the second most frequent cause of death (after cancer) among HIV-positive subjects. The clinical use of highly active antiretroviral therapy (HAART) has dramatically reduced mortality and morbidity in HIV-positive population, leading to prolonged and improved quality of life. However, as mortality and morbidity from AIDS-related conditions improve, CVD assumes increasing magnitude. It is estimated that by 2015 more than 50% of HIV-positive patients will be older than 50 years. Since age is a major unmodifiable cardiovascular risk factor, the risk for CVD in this population will significantly and progressively increase in the near future. A large part of the risk for cardiovascular events appears to be a result of lipid abnormalities characterizing HIV-positive persons. This review focuses on HIV-associated lipid abnormalities and CVD. Lipid abnormalities may be related to either viral infection, HAART or both. Dyslipidemia characterizing HIV-infected patients has become a therapeutic target to reduce cardiovascular risk of HIV-treated patients. HAART-treated patients show an atherogenic lipid profile comprised of low HDL-cholesterol levels, hypertrigliceridemia and increased levels of small-LDL particles. Current guidelines for the treatment of dyslipidemia and reducing cardiovascular risk in HIV-positive patients suggest that when lifestyle modifications (i.e., diet and exercise) and switching antiretroviral therapy are not enough, statins should be the first-line therapy for dyslipidemia. HDL raising interventions (niacin and fibrates) should be considered to raise HDL levels and lower triglyceride in HIV-infected patients. Implications of lipid-related interventions in HIV-treated patients to avoid drug interactions and their adverse effects are also discussed.
authors: AtheroThrombosis Research Unit, Cardiovascular Institute, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, United States.
authors: Chiara
authors: C
authors: Giannarelli
authors: Robert S
authors: RS
authors: Klein
authors: Juan J
authors: JJ
authors: Badimon
mesh_terms: D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000517:prevention & control / Q000821:virology*; D004032:Diet / Q000009:adverse effects; D057915:Drug Substitution; D050171:Dyslipidemias / Q000175:diagnosis / Q000628:therapy / Q000821:virology*; D042241:Early Diagnosis; D015444:Exercise; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000821:virology*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors