Cardiovascular implications of HIV-induced dyslipidemia

• Published in: Atherosclerosis Vol. 219; no. 2; pp. 384 - 389
• Main Authors: Giannarelli, Chiara, Klein, Robert S., Badimon, Juan J.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ireland Ltd 01.12.2011; Elsevier
• Subjects: adverse effects; Antiretroviral Therapy, Highly Active; Antiretroviral Therapy, Highly Active - adverse effects; Atherosclerosis; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Cardiovascular Diseases; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - prevention & control; Cardiovascular Diseases - virology; complications; death; diagnosis; diet; Diet - adverse effects; drug interactions; Drug Substitution; drug therapy; Drug toxicity and drugs side effects treatment; Dyslipidemia; Dyslipidemias; Dyslipidemias - diagnosis; Dyslipidemias - therapy; Dyslipidemias - virology; Early Diagnosis; Exercise; guidelines; high density lipoprotein cholesterol; HIV; HIV Infections; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - virology; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; hyperlipidemia; lifestyle; Medical sciences; morbidity; mortality; niacin; patients; people; Pharmacology. Drug treatments; Predictive Value of Tests; prevention & control; quality of life; risk; Risk Assessment; Risk Factors; Risk Reduction Behavior; therapeutics; therapy; Toxicity: blood; Treatment Outcome; triacylglycerols; virology; Cardiovascular disease; HIV; Dyslipidemia; Atherosclerosis; Vascular disease; Virus; Retroviridae; Metabolic diseases; Lipids; Human immunodeficiency virus; Dyslipemia; Lentivirus
• ISSN: 0021-9150; 1879-1484; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2011.06.003

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.