Fantoni Massimo, Del Borgo Cosmo, Autore Camillo
Istituto di Clinica delle Malattie Infettive, Università Cattolica Sacro Cuore, Roma, Italy.
AIDS. 2003 Apr;17 Suppl 1:S162-9. doi: 10.1097/00002030-200304001-00020.
A number of metabolic disorders, including hypercholesterolemia, hypertriglyceridemia, insulin resistance, elevated fasting glucose and diabetes mellitus, were reported in a high proportion of HIV-infected patients receiving highly active antiretroviral therapy (HAART). Less frequently, coagulative disorders were described in patients receiving HAART. Since all these metabolic disorders may predispose to coronary heart disease, an early evaluation and treatment is advisable. Existing guidelines for uninfected patients may be applied, taking into account, however, the potential for drug interactions and accumulated toxicity. It may be helpful to stratify all patients in three risk groups to plan regular diagnostic screening. Treatment of dyslipidemia and diabetes mellitus should include a first-line approach with non-pharmacological interventions. Statins and fibrates are proposed for HIV-infected patients with HAART-related hyperlipidemia, but concern has been raised on their potential for interaction with antiretrovirals and hepatic and muscle toxicity. Metformin and thiazolidenediones (or glitazones), hypoglycemic agents that increase insulin sensitivity, are presently under evaluation in diabetic and glucose-intolerant HIV-infected patients treated with HAART. Glitazones also have a potential for ameliorating the lipodystrophic syndrome. The routine evaluation of coagulative parameters is probably not advisable until a benefit of widespread screening is assessed in prospective studies. A heightened awareness of the possiblity of coagulative disorders, together with controlled trials and basic research, is needed.
在接受高效抗逆转录病毒治疗（HAART）的大量HIV感染患者中，报告了多种代谢紊乱情况，包括高胆固醇血症、高甘油三酯血症、胰岛素抵抗、空腹血糖升高和糖尿病。接受HAART的患者较少出现凝血障碍。由于所有这些代谢紊乱都可能诱发冠心病，因此建议进行早期评估和治疗。可以应用针对未感染患者的现有指南，但要考虑到药物相互作用和累积毒性的可能性。将所有患者分为三个风险组以计划定期诊断筛查可能会有所帮助。血脂异常和糖尿病的治疗应包括非药物干预的一线方法。对于患有HAART相关高脂血症的HIV感染患者，建议使用他汀类药物和贝特类药物，但人们对它们与抗逆转录病毒药物相互作用的可能性以及肝毒性和肌肉毒性表示担忧。二甲双胍和噻唑烷二酮类药物（或格列酮类药物）是增加胰岛素敏感性的降糖药物，目前正在接受HAART治疗的糖尿病和糖耐量异常的HIV感染患者中进行评估。格列酮类药物也有可能改善脂肪代谢障碍综合征。在通过前瞻性研究评估广泛筛查的益处之前，常规评估凝血参数可能不可取。需要提高对凝血障碍可能性的认识，并开展对照试验和基础研究。
