Cardiovascular risk in patients with HIV Infection: impact of antiretroviral therapy.

摘要: Increased coronary heart disease risk in HIV-positive patients using antiretroviral therapy (ART) has been a controversial topic since 1998 when the dyslipidaemic effect of protease inhibitors (PIs) was recognised. Accumulating evidence suggests an association between ART and increased risk. In 2003, large, prospective D:A:D (Data Collection on Adverse Events Anti-HIV Drugs) study reported 26% relative increase rate myocardial infarction per year exposure during first 4-6 years use. As HIV-population grows older, infectious specialists have to consider unfamiliar areas internal medicine such as lipid-lowering smoking cessation. Moreover, regimen itself may be modifiable factor, there are both class differences within-class tendency lipids. Most nucleoside reverse transcriptase (NRTIs), including newer agents tenofovir disoproxil fumarate emtricitabine, little or no lipid levels glucose metabolism. One exception is highly effective NRTI stavudine, which profile negative contrast non-nucleoside inhibitor nevirapine 'good cholesterol' high-density lipoprotein (HDL) cholesterol thus reduce total : HDL index. PIs some effect, especially ritonavir (alone combination with other PIs), fosamprenavir novel PI tipranavir. Only atazanavir, extent saquinavir, seem Studies blood pressure contradictory. Apart from recent report where lower found receiving NNRTIs, influence individual drugs unknown. When hypertension detected patient, creatinine clearance (CL(CR)) should calculated urine checked for proteinuria. CL(CR) <30 mL/min, not recommended. Many hypertensive proteinuria ACE angiotensin II receptor antagonist better choice than thiazide diuretic calcium channel these patients. addition, physicians treating aware long list possible interactions anti-hypertensive- drugs. This review discusses important clinical aspects middle-aged who experiencing cardiovascular event.