Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV: A Scientific Statement From the American Heart Association.
Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV: A Scientific Statement From the American Heart Association.
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DOI：
10.1161/cir.0000000000000695
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发表时间：
2019-07-09
期刊：
影响因子：
37.8
通讯作者：
Post WS
中科院分区：
文献类型：
--
作者：
Feinstein MJ;Hsue PY;Benjamin LA;Bloomfield GS;Currier JS;Freiberg MS;Grinspoon SK;Levin J;Longenecker CT;Post WS
随着早期和有效的抗逆转录病毒治疗变得更加普遍，艾滋病毒已从一种进行性、致命性疾病转变为一种慢性、可管理的疾病，其特征是慢性共病（包括心血管疾病）的风险增加。心肌梗死、心力衰竭、中风和其他心血管疾病表现（包括肺动脉高压和心源性猝死）的发生率，艾滋病毒感染者明显高于未感染的对照组，即使在使用有效抗逆转录病毒治疗抑制艾滋病毒的情况下也是如此。在考虑人口统计学和临床风险因素后，这些风险升高通常持续存在，可能部分归因于慢性炎症和免疫失调。HIV长期CVD结果的数据受到HIV向慢性疾病的相对近期流行病学转变的限制。因此，我们对HIV CVD发病机制、预防和治疗的理解依赖于大型观察性研究、HIV治疗的随机对照试验，这些试验检测CVD终点的能力不足，以及检查替代CVD终点的小型干预性研究。本文件的目的是对HIV相关CVD的现有证据进行全面审查，特别是动脉粥样硬化CVD（包括心肌梗死和卒中）和心力衰竭，以及在缺乏大规模随机对照试验数据的情况下如何预防和治疗HIV相关CVD的实用建议。本声明适用于照顾HIV感染者、HIV感染者以及对HIV相关CVD感兴趣的临床和转化研究人员的临床医生。
As early and effective antiretroviral therapy has become more widespread, HIV has transitioned from a progressive, fatal disease to a chronic, manageable disease marked by elevated risk of chronic comorbid diseases, including cardiovascular diseases (CVDs). Rates of myocardial infarction, heart failure, stroke, and other CVD manifestations, including pulmonary hypertension and sudden cardiac death, are significantly higher for people living with HIV than for uninfected control subjects, even in the setting of HIV viral suppression with effective antiretroviral therapy. These elevated risks generally persist after demographic and clinical risk factors are accounted for and may be partly attributed to chronic inflammation and immune dysregulation. Data on long-term CVD outcomes in HIV are limited by the relatively recent epidemiological transition of HIV to a chronic disease. Therefore, our understanding of CVD pathogenesis, prevention, and treatment in HIV relies on large observational studies, randomized controlled trials of HIV therapies that are underpowered to detect CVD end points, and small interventional studies examining surrogate CVD end points. The purpose of this document is to provide a thorough review of the existing evidence on HIV-associated CVD, in particular atherosclerotic CVD (including myocardial infarction and stroke) and heart failure, as well as pragmatic recommendations on how to approach CVD prevention and treatment in HIV in the absence of large-scale randomized controlled trial data. This statement is intended for clinicians caring for people with HIV, individuals living with HIV, and clinical and translational researchers interested in HIV-associated CVD.