Mooser Vincent
Department of Internal Medicine, CHUV University Hospital, Lausanne, Switzerland.
AIDS. 2003 Apr;17 Suppl 1:S65-9. doi: 10.1097/00002030-200304001-00009.
Whether the atherogenic metabolic side effects of highly active antiretroviral therapy (HAART) (lipid disorders and glucose intolerance/diabetes) will translate, in the long term, into an increased incidence of cardiovascular events that would offset the survival benefits of this type of therapy is a matter of intense concern. This concern has been substantiated by a series of case reports of HIV-infected patients who had experienced unexplained cardiovascular disease. However, in the absence of prospective, large cohort studies, the answer to this question at present remains elusive. Indirect evidence, from retrospective cohort analyses and non-invasive imaging of peripheral arteries, indicates that HIV-infected persons are at higher risk for atherosclerosis than HIV-negative individuals. However, this risk does not appear to be attributable to HAART. Pending the availability of further data, a global assessment of the risk for heart disease should be performed in all HAART-treated HIV-infected patients, taking into account age and the presence of major risk factors. There is so far no evidence, from a cardiovascular standpoint, to limit administration of HAART. However, interventions on modifiable risk factors, including smoking cessation, are strongly recommended, particularly in high-risk patients.
高效抗逆转录病毒治疗（HAART）的致动脉粥样硬化代谢副作用（脂质紊乱和葡萄糖不耐受/糖尿病）从长远来看是否会转化为心血管事件发生率的增加，从而抵消这类治疗带来的生存益处，这是一个备受关注的问题。一系列感染HIV的患者出现不明原因心血管疾病的病例报告证实了这种担忧。然而，由于缺乏前瞻性的大型队列研究，目前这个问题的答案仍然难以捉摸。来自回顾性队列分析和外周动脉无创成像的间接证据表明，与未感染HIV的个体相比，感染HIV的人患动脉粥样硬化的风险更高。然而，这种风险似乎并非归因于HAART。在获得更多数据之前，应对所有接受HAART治疗的HIV感染患者进行心脏病风险的全面评估，同时考虑年龄和主要风险因素的存在情况。从心血管角度来看，目前尚无证据限制HAART的使用。然而，强烈建议对包括戒烟在内的可改变风险因素进行干预，尤其是在高危患者中。
