Dyslipidaemia associated with antiretroviral therapy in HIV-infected patients
Dyslipidaemia associated with antiretroviral therapy in HIV-infected patients
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DOI：
10.1093/jac/dkh013
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发表时间：
2004-01-01
影响因子：
5.2
通讯作者：
Chiodo, F
中科院分区：
文献类型：
--
作者：
Calza, L;Manfredi, R;Chiodo, F
高效抗逆转录病毒疗法（HAART）对人类免疫缺陷病毒（HIV）感染的自然史产生了重大影响，导致其发病率和死亡率显着下降，但经常与临床和代谢并发症相关。在接受基于蛋白酶抑制剂（PI）的抗逆转录病毒疗法治疗的受试者中，脂肪重新分布或脂肪营养不良、高甘油三酯血症、高胆固醇血症、胰岛素抵抗和糖尿病已被广泛报道。特别是，接受HAART治疗的HIV感染者中高达70-80%会出现血脂异常，并且可能与所有可用的PI相关，尽管高甘油三酯血症似乎在接受利托那韦、利托那韦-沙奎那韦或利托那韦-洛匹那韦治疗的患者中更为常见。 HAART 相关高脂血症的潜在长期后果尚不完全清楚，但据报道，接受 PI 治疗的年轻 HIV 阳性患者发生过早冠状动脉疾病的风险增加。饮食改变、定期有氧运动和改用保留 PI 的方案可能对血脂异常有有利作用。通常需要使用他汀类药物或贝特类药物进行降脂治疗。降血脂药物的选择应考虑与抗逆转录病毒药物的潜在药理学相互作用。
Highly active antiretroviral therapy (HAART) has had a significant impact on the natural history of human immunodeficiency virus (HIV) infection, leading to a remarkable decrease in its morbidity and mortality, but is frequently associated with clinical and metabolic complications. Fat redistribution or lipodystrophy, hypertriglyceridaemia, hypercholesterolaemia, insulin resistance and diabetes mellitus have been extensively reported in subjects treated with protease inhibitor (PI)-based antiretroviral regimens. In particular, dyslipidaemia occurs in up to 70-80% of HIV-infected individuals receiving HAART and can be associated with all the available PIs, although hypertriglyceridaemia appears to be more frequent in patients treated with ritonavir, ritonavir-saquinavir, or ritonavir-lopinavir. The potential long-term consequences of HAART-associated hyperlipidaemia are not completely understood, but an increased risk of premature coronary artery disease has been reported in young HIV-positive persons receiving PIs. Dietary changes, regular aerobic exercise and switching to a PI-sparing regimen may act favourably on dyslipidaemia. Lipid-lowering therapy is often required with statins or fibrates. The choice of hypolipidaemic drugs should take into account potential pharmacological interactions with antiretroviral agents.