The consequences of HIV infection and antiretroviral therapy use for cardiovascular disease risk: shifting paradigms.
The consequences of HIV infection and antiretroviral therapy use for cardiovascular disease risk: shifting paradigms.
复制标题
DOI：
10.1097/coh.0b013e328329c62f
复制
发表时间：
2009-05
影响因子：
4.1
通讯作者：
Neaton JD
中科院分区：
文献类型：
--
作者：
Baker JV;Henry WK;Neaton JD
探讨HIV感染和抗逆转录病毒治疗（ART）可能增加动脉粥样硬化性心血管疾病（CVD）风险的机制，并注意早期开始ART的影响（即CD 4计数高于指南目前推荐的水平）。与一般人群相比，接受ART的HIV感染患者有更大的亚临床和临床动脉粥样硬化疾病负担。最近的一项国际治疗中断试验（SMART）的结果将注意力从ART相关的药物毒性转向更好地了解未经治疗的HIV感染的后果，这可能会通过炎症，血栓形成途径的上调以及最终的早期血管损伤和功能障碍增加CVD风险。此外，CVD风险可能会增加一些ART，这种风险可能是类别和/或药物特异性的。与未经治疗的HIV相比，ART可能会增加或减少CVD的风险。关于相对风险的可靠数据并不存在。早期ART的随机试验将为评估ART对CVD的净风险和益处提供最佳数据。
To explore the mechanisms by which HIV infection and antiretroviral therapy (ART) may increase risk for atherosclerotic cardiovascular disease (CVD), with attention to the implications of earlier initiation of ART (i.e. at higher CD4 counts than currently recommended by guidelines). Compared to the general population, HIV-infected patients receiving ART have a greater burden of subclinical and clinical atherosclerotic disease. Findings from a recent international treatment interruption trial (SMART) has redirected attention from ART-related drug toxicity toward a better appreciation for the consequences of untreated HIV infection, which may increase CVD risk through inflammation, up-regulation of thrombotic pathways, and ultimately early vascular damage and dysfunction. In addition, CVD risk may increase with some ART, and this risk may be class- and/or drug-specific. Compared to untreated HIV, ART may increase or decrease risk of CVD. Reliable data on the relative risk does not exist. A randomized trial of early ART will provide the best data for assessing the net risks and benefits of ART use on CVD.