Drugs and cardiotoxicity in HIV and AIDS
Drugs and cardiotoxicity in HIV and AIDS
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DOI：
10.1111/j.1749-6632.2001.tb03912.x
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发表时间：
2001-01-01
期刊：
影响因子：
--
通讯作者：
Del Borgo, C
中科院分区：
文献类型：
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作者：
Fantoni, M;Autore, C;Del Borgo, C
近年来，强效抗逆转录病毒药物的出现对艾滋病毒感染者的死亡率和疾病进展产生了令人印象深刻的影响，因此，与药物的长期影响有关的问题日益重要。高血糖症、高血糖症和脂肪代谢障碍是高效抗逆转录病毒治疗（HAART）的不良反应，尤其是在使用蛋白酶抑制剂时。高血压与大多数可用的蛋白酶抑制剂的使用显著相关，估计患病率高达50%。由于观察期较短，心血管事件数量较少，目前尚不足以证明接受HAART治疗的HIV感染患者发生冠心病风险增加的流行病学证据;然而，很可能不久将积累更多的数据来量化这种风险。在开始HAART之前和治疗期间，对所有患者进行传统冠状动脉危险因素（包括血脂）评估是合理的。在目前用于HIV+患者的药物中，抗菌药物、抗真菌药、精神药物和抗组胺药与QT间期延长或尖端扭转型室性心动过速（一种危及生命的室性心律失常）相关。在可能将无症状心电图异常加速为危险心律失常的风险因素中，伴随使用共享CYP 3A代谢途径的药物。由于大多数蛋白酶抑制剂是CYP 3A的强效抑制剂，临床医生应该意识到HAART的这种潜在危险作用。蒽环类抗生素是一种有效的细胞毒性抗生素，已广泛用于治疗HIV相关肿瘤。它们的心脏毒性是众所周知的，从良性和可逆的心律失常到进行性严重心肌病。HIV阳性患者生存率和生活质量的提高强调了高度认识药物相关心脏不良反应的重要性。
The advent of potent antiretroviral drugs in recent years has had an impressive impact on mortality and disease progression in HIV-infected patients, so that issues related to long-term effects of drugs are of growing importance. Hyperlipidemia, hyperglycemia, and lipodystrophy are increasingly described adverse effects of highly active antiretroviral therapy (HAART), in particular when protease inhibitors are used. Hyperlipidemia is strikingly associated with the use of most available protease inhibitors, with an estimated prevalence of up to 50%. Because of the short observation period and the small number of cardiovascular events, epidemiological evidence for an increased risk of coronary heart disease in HIV-infected patients treated with HAART is not adequate at present; however, it is likely that shortly more data will accumulate to quantify this risk. Before starting HAART and during treatment it is reasonable to evaluate all patients for traditional coronary risk factors, including lipid profile. Among the drugs that are currently used in HIV+ patients, antibacterials, antifungals, psychotropic drugs and anti-histamines have been associated with QT prolongation or torsade de pointe, a life-threatening ventricular arrhythmia. Among the risk factors that may precipitate an asymptomatic electrocardiographic abnormality into a dangerous arrhythmia is the concomitant use of drugs that share the CYP3A metabolic pathway. Since most protease inhibitors are potent inhibitors of CYP3A, clinicians should be aware of this potentially dangerous effect of HAART. Anthracyclines are potent cytotoxic antibiotics that have been widely used for the treatment of HIV-related neoplasms. Their cardiotoxicity is well known, ranging from benign and reversible arrhythmias to progressive severe cardiomyopathy. The increased survival and quality of life of HIV+ patients emphasize the importance of a high awareness of adverse drug-related cardiac effects.