Aberg Judith A
Division of Infectious Diseases School of Medicine, Washington University, St. Louis, Missouri, USA.
J Int Assoc Physicians AIDS Care (Chic). 2003 Sep;2 Suppl 2:S24-39.
Dyslipidemia is now recognized as a significant potential adverse event in HIV-positive patients who are on ART. The tide of evidence continues to flow between the shore of HIV being the primary factor behind increased cardiovascular risk in HIV-positive patients, and the ocean of HAART being the primary cause. However, there clearly is an association between long-term infection with HIV and metabolic abnormalities. HIV-infected adults should undergo evaluation and treatment based on the NCEP ATP III guidelines. The NCEP recommends non-pharmacologic interventions be given a thorough trial prior to consideration of drug therapy. The recommendations also stipulate that intensive therapy with lipid-lowering medications should be used in individuals with metabolic syndrome. This includes aggressive treatment of hypertension, diabetes, and dyslipidemia. The NCEP also emphasizes the importance of smoking cessation, weight reduction, increased physical activity, and a salubrious diet. The fundamental message still is that physicians must treat HIV infection first. The choice of ART depends on many patient-specific factors, of which cardiovascular risk is only one.
血脂异常现已被认为是接受抗逆转录病毒治疗（ART）的HIV阳性患者中一种重要的潜在不良事件。在HIV阳性患者心血管风险增加的主要因素是HIV这一观点与HAART是主要原因这一观点之间，证据的潮流仍在二者之间涌动。然而，HIV的长期感染与代谢异常之间显然存在关联。HIV感染的成年人应根据美国国家胆固醇教育计划成人治疗组第三次报告（NCEP ATP III）指南接受评估和治疗。NCEP建议在考虑药物治疗之前，应先对非药物干预措施进行全面试验。这些建议还规定，对于患有代谢综合征的个体，应使用强化降脂药物治疗。这包括积极治疗高血压、糖尿病和血脂异常。NCEP还强调戒烟、减重、增加体力活动和健康饮食的重要性。基本信息仍然是，医生必须首先治疗HIV感染。ART的选择取决于许多患者特有的因素，其中心血管风险只是其中之一。
