European AIDS Clinical Society (EACS) guidelines on the prevention and management of metabolic diseases in HIV
European AIDS Clinical Society (EACS) guidelines on the prevention and management of metabolic diseases in HIV
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DOI：
10.1111/j.1468-1293.2007.00534.x
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发表时间：
2008-02-01
期刊：
影响因子：
3
通讯作者：
Vigano, A.
中科院分区：
文献类型：
--
作者：
Lundgren, J. D.;Battegay, M.;Vigano, A.
背景：在艾滋病毒感染者中经常观察到代谢性疾病，由于感染这些疾病的风险与年龄有关，由于抗逆转录病毒治疗（ART）的益处，这些疾病的患病率将在未来增加。所有艾滋病毒感染者应定期接受代谢性疾病、血脂异常、糖尿病、高血压和身体组成改变史的筛查；还应评估心血管风险和肾功能。预防心血管疾病的力度将根据个人患缺血性心脏病的绝对风险而有所不同，并且应该是全面的。生活方式干预应侧重于戒烟、调整饮食和定期锻炼等方面的咨询。健康的饮食、运动和保持正常的体重有助于减少血脂异常；如果没有效果，应考虑改变抗逆转录病毒治疗，然后在高危患者使用降脂药物。建议从胸苷类似物中先发制人地切换，以降低发生或进展脂肪萎缩的风险。腹内脂肪的积累最好通过运动和饮食来控制。预防和管理2型糖尿病和高血压遵循一般人群使用的指南。当使用医疗干预措施来预防和/或治疗代谢性疾病时，应考虑到药代动力学相互作用和依从性受损的可能性，以避免抗逆转录病毒治疗的疗效受损。H[V]专科医生和代谢性疾病专科医生应相互咨询，特别是在难治性病例中。结论hfv感染者代谢性疾病的预防方法多样且相对简单；应优先考虑感染这些疾病的高危患者。
BackgroundMetabolic diseases are frequently observed in HIV-infected persons and, as the risk of contracting these diseases is age-related, their prevalence will increase in the future as a consequence of the benefits of antiretroviral therapy (ART).Summary of guidelinesAll HIV-infected persons should be screened at regular intervals for a history of metabolic disease, dyslipidaemia, diabetes mellitus, hypertension and alteration of body composition; cardiovascular risk and renal function should also be assessed. Efforts to prevent cardiovascular disease will vary in intensity depending on an individual's absolute risk of ischaemic heart disease and should be comprehensive in nature. Lifestyle interventions should focus on counselling to stop smoking, modify diet and take regular exercise. A healthy diet, exercise and maintaining normal body weight tend to reduce dyslipidaemia; if not effective, a change of ART should be considered, followed by use of lipid-lowering medication in high-risk patients. A pre-emptive switch from thymidine analogues is recommended to reduce the risk of development or progression of lipoatrophy. Intra-abdominal fat accumulation is best managed by exercise and diet. Prevention and management of type 2 diabetes mellitus and hypertension follow guidelines used in the general population. When using medical interventions to prevent and/or treat metabolic disease(s), impairment of the efficacy of ART should be avoided by considering the possibility of pharmacokinetic interactions and compromised adherence. Specialists in H[V and specialists in metabolic diseases should consult each other, in particular in difficult-to-treat cases.ConclusionMultiple and relatively simple approaches exist to prevent metabolic diseases in HfV-infected persons; priority should be given to patients at high risk of contracting these diseases.