title: Drug therapies for HIV-related metabolic disorders.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV) has become a chronic disease often associated with dyslipidaemia and insulin resistance. Combination antiretroviral therapy (cART) may contribute to metabolic disturbances, eventually leading to increased cardiovascular disease (CVR) in this population. Escalating interventions to decrease CVR include promoting a healthy lifestyle, such as quitting smoking, diet and regular exercise. If they do not achieve the goals, a change of cART should be considered, followed by or used concomitantly with the use of chemical therapies.
  
  
  METHODS
  The aim of this article is to review the available drug therapies for the treatment of metabolic disorders in HIV-infected patients and to examine their safety and effectiveness in this population. A review of the literature was conducted, highlighting the most relevant articles.
  
  
  CONCLUSIONS
  Switching strategies can be useful but its expected benefit is not high. Therefore, chemical intervention is often needed. Statins have been proven to reduce CVR in the general population and in HIV-infected patients. Simvastatin is contraindicated in patients treated with boosted PI due to interactions; atorvastatin is safe at submaximal dose and needs close monitoring, while pravastatin lacks lipid-lowering potency, and rosuvastatin and pitavastatin are safe. Ezetimibe and fibrates are also safe and effective in HIV-infected patients and can be used in combination with statins. The management of glucose homeostatic disorders in HIV-infected patients follows the same guidelines as in the general population. However, there are specific considerations with respect to the interactions of particular medications with cART. When drug therapy is needed, metformin is the first-line drug. Decisions regarding second- and third-line drugs should be carefully individualized.
authors.affiliation: a Infectious Diseases Unit , Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona , Barcelona , Spain.
authors.forename: Karuna
authors.initials: K
authors.lastname: Lamarca
authors.affiliation: a Infectious Diseases Unit , Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona , Barcelona , Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: García Sarasola
authors.affiliation: b Infectious Diseases Unit , Hospital Universitari Joan XXIII , Tarragona , Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Vidal
authors.affiliation: c Infectious Diseases Department, Institut de Recerca Biomèdica (IRB) de Lleida , Hospitals Universitaris Arnau de Vilanova & Santa María, Universitat de Lleida , Lleida , Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Domingo
mesh_terms: D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000209:etiology; D050171:Dyslipidemias / Q000188:drug therapy* / Q000209:etiology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D000068718:Rosuvastatin Calcium / Q000627:therapeutic use; D019821:Simvastatin / Q000627:therapeutic use
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000068718:Rosuvastatin Calcium; D019821:Simvastatin
keywords: Combination antiretroviral therapy; cardiovascular risk; ezetimibe; fibrates; metabolic complications; metformin; statins