Barbaro Giuseppe
Department of Medical Pathophysiology, University of Rome "La Sapienza", Rome, Italy.
Am J Ther. 2006 May-Jun;13(3):248-60. doi: 10.1097/01.mjt.0000162013.66614.16.
The introduction of highly active antiretroviral therapy (HAART) has significantly modified the course of HIV disease, with longer survival and improved quality of life of HIV-infected subjects. However, HAART regimens, especially those including protease inhibitors (PIs) have been shown to cause in a high proportion of HIV-infected patients a metabolic syndrome that may be associated with an increased risk of cardiovascular disease (about 1.4 cardiac events per 1,000 years of therapy according to the Framingham score). Metabolic features associated with somatic changes (lipodystrophy/lipoatrophy) include dyslipidemia (about 70% of patients), insulin resistance (elevated C-peptide and insulin), type 2 diabetes mellitus (8%-10% of the patients), hypertension (up to 75% of patients), coagulation abnormalities (25% of patients), lactic acidemia, and elevated hepatic transaminases (nonalcoholic steatohepatitis). HAART-associated metabolic syndrome is an increasingly recognized clinical entity. A better understanding of the molecular mechanisms responsible for this syndrome will lead to the discovery of new drugs that will reduce the cardiovascular risk in patients under HAART. A careful stratification of the cardiovascular risk and cardiovascular monitoring of patients under HAART is needed according to the most recent clinical guidelines.
高效抗逆转录病毒疗法（HAART）的引入显著改变了HIV疾病的进程，使HIV感染患者的生存期延长，生活质量提高。然而，HAART方案，尤其是那些包含蛋白酶抑制剂（PIs）的方案，已被证明在很大比例的HIV感染患者中会引发一种代谢综合征，这种综合征可能与心血管疾病风险增加有关（根据弗雷明汉姆评分，每1000年治疗约有1.4次心脏事件）。与身体变化（脂肪营养不良/脂肪萎缩）相关的代谢特征包括血脂异常（约70%的患者）、胰岛素抵抗（C肽和胰岛素升高）、2型糖尿病（8%-10%的患者）、高血压（高达75%的患者）、凝血异常（25%的患者）、乳酸性酸中毒以及肝转氨酶升高（非酒精性脂肪性肝炎）。HAART相关的代谢综合征是一个越来越被认可的临床实体。更好地理解导致该综合征的分子机制将有助于发现新的药物，从而降低接受HAART治疗患者的心血管风险。根据最新临床指南，需要对接受HAART治疗的患者进行仔细的心血管风险分层和心血管监测。
