Does antiretroviral therapy increase or decrease the risk of cardiovascular disease?
Does antiretroviral therapy increase or decrease the risk of cardiovascular disease?
复制标题
DOI：
10.1007/s11904-010-0045-5
复制
发表时间：
2010-05-01
影响因子：
4.6
通讯作者：
Fichtenbaum, Carl J
中科院分区：
文献类型：
--
作者：
Fichtenbaum, Carl J
动脉粥样硬化是一种复杂的炎症过程，已被认为是艾滋病毒感染者的一个重要问题。流行病学研究表明，某些抗逆转录病毒药物(一些核苷逆转录酶抑制剂和蛋白酶抑制剂)与冠心病(CHD)的风险更高。相反，非核苷逆转录酶抑制剂、进入抑制剂和整合酶抑制剂似乎是中性的。HIV感染是一种慢性炎症过程，与内皮功能障碍、致动脉粥样硬化性血脂异常以及冠心病的高风险相关。在短期内开始抗逆转录病毒治疗似乎降低了冠心病的风险，无论使用的是哪种特定的药物。然而，缺乏以CHD为主要终点的抗逆转录病毒治疗的充足动力的随机试验。因此，抗逆转录病毒治疗是否会增加或降低艾滋病毒携带者患冠心病的风险的证据令人困惑。本文综述了目前关于HIV和抗逆转录病毒治疗在心血管疾病发展中的作用的争议。
Atherosclerosis is a complex inflammatory process that has been identified as an important problem in persons with HIV infection. Epidemiologic studies have linked certain antiretroviral medications (some nucleoside reverse transcriptase inhibitors and protease inhibitors) with a higher risk of coronary heart disease (CHD). Conversely, nonnucleoside reverse transcriptase inhibitors, entry inhibitors, and integrase inhibitors appear neutral. HIV infection is a chronic inflammatory process associated with endothelial dysfunction, atherogenic dyslipidemia, and a higher risk for CHD. Initiation of antiretroviral therapy in the short term appears to lower CHD risk, regardless of the specific agents used. However, adequately powered randomized trials of antiretroviral therapy with CHD as a primary end point are lacking. Thus, the evidence of whether antiretroviral therapy increases or decreases CHD risk in persons with HIV is perplexing. This article reviews the current controversy of the role of HIV and antiretroviral therapy in the development of cardiovascular disease.