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HIV与艾滋病中的药物及心脏毒性

Drugs and cardiotoxicity in HIV and AIDS.

作者信息

Fantoni M, Autore C, Del Borgo C

机构信息

Department of Infectious Diseases, Catholic University, Rome, Italy.

出版信息

Ann N Y Acad Sci. 2001 Nov;946:179-99. doi: 10.1111/j.1749-6632.2001.tb03912.x.

Abstract

The advent of potent antiretroviral drugs in recent years has had an impressive impact on mortality and disease progression in HIV-infected patients, so that issues related to long-term effects of drugs are of growing importance. Hyperlipidemia, hyperglycemia, and lipodystrophy are increasingly described adverse effects of highly active antiretroviral therapy (HAART), in particular when protease inhibitors are used. Hyperlipidemia is strikingly associated with the use of most available protease inhibitors, with an estimated prevalence of up to 50%. Because of the short observation period and the small number of cardiovascular events, epidemiological evidence for an increased risk of coronary heart disease in HIV-infected patients treated with HAART is not adequate at present; however, it is likely that shortly more data will accumulate to quantify this risk. Before starting HAART and during treatment it is reasonable to evaluate all patients for traditional coronary risk factors, including lipid profile. Among the drugs that are currently used in HIV+ patients, antibacterials, antifungals, psychotropic drugs and anti-histamines have been associated with QT prolongation or torsade de pointe, a life-threatening ventricular arrhythmia. Among the risk factors that may precipitate an asymptomatic electrocardiographic abnormality into a dangerous arrhythmia is the concomitant use of drugs that share the CYP3A metabolic pathway. Since most protease inhibitors are potent inhibitors of CYP3A, clinicians should be aware of this potentially dangerous effect of HAART. Anthracyclines are potent cytotoxic antibiotics that have been widely used for the treatment of HIV-related neoplasms. Their cardiotoxicity is well known, ranging from benign and reversible arrhythmias to progressive severe cardiomyopathy. The increased survival and quality of life of HIV+ patients emphasize the importance of a high awareness of adverse drug-related cardiac effects.

摘要

近年来,强效抗逆转录病毒药物的出现对HIV感染患者的死亡率和疾病进展产生了显著影响,因此与药物长期影响相关的问题日益重要。高脂血症、高血糖和脂肪代谢障碍越来越多地被描述为高效抗逆转录病毒疗法(HAART)的不良反应,尤其是在使用蛋白酶抑制剂时。高脂血症与大多数现有蛋白酶抑制剂的使用显著相关,估计患病率高达50%。由于观察期短且心血管事件数量少,目前尚无足够的流行病学证据表明接受HAART治疗的HIV感染患者患冠心病的风险增加;然而,不久可能会积累更多数据来量化这一风险。在开始HAART之前和治疗期间,对所有患者评估传统的冠心病危险因素,包括血脂谱,是合理的。在目前用于HIV阳性患者的药物中,抗菌药物、抗真菌药物、精神药物和抗组胺药物与QT间期延长或尖端扭转型室速有关,后者是一种危及生命的室性心律失常。可能将无症状心电图异常转变为危险心律失常的危险因素之一是同时使用共享CYP3A代谢途径的药物。由于大多数蛋白酶抑制剂是CYP3A的强效抑制剂,临床医生应意识到HAART的这种潜在危险作用。蒽环类药物是强效细胞毒性抗生素,已广泛用于治疗HIV相关肿瘤。其心脏毒性众所周知,从良性可逆性心律失常到进行性严重心肌病不等。HIV阳性患者生存率和生活质量的提高凸显了高度警惕药物相关心脏不良反应的重要性。

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