Calza Leonardo, Manfredi Roberto, Pocaterra Daria, Chiodo Francesco
Department of Clinical and Experimental Medicine, Section of Infectious Diseases, Alma Mater Studiorum University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
J Infect. 2008 Jul;57(1):16-32. doi: 10.1016/j.jinf.2008.02.006. Epub 2008 Mar 21.
The use of new potent protease inhibitor-based antiretroviral therapies in patients with human immunodeficiency virus (HIV) infection has been increasingly associated with cardiovascular risk factors, including hyperlipidaemia, fat redistribution syndrome, insulin resistance, and diabetes mellitus. The introduction of highly active antiretroviral therapy (HAART) in clinical practice has remarkably changed the natural history of HIV disease, leading to a notable extension of life expectancy, and prolonged lipid and glucose metabolism abnormalities are expected to lead to significant effects on the long-term prognosis and outcome of HIV-infected patients. Prediction modeling, surrogate markers and hard cardiovascular endpoints suggest an increased incidence of cardiovascular diseases in HIV-infected subjects receiving HAART, even though the absolute risk of cardiovascular complications remains still low, and must be balanced against the evident virological, immunological, and clinical benefits descending from combination antiretroviral therapy. Nevertheless, the assessment of cardiovascular risk should be performed on regular basis in HIV-positive individuals, especially after initiation or change of antiretroviral treatment. Appropriate lifestyle measures (including smoking cessation, dietary changes, and aerobic physical activity) are critical points, and switching HAART may be considered, although maintaining viremic control should be the main goal of therapy. Pharmacological treatment of dyslipidaemia (usually with statins and fibrates), and hyperglycaemia (with insulin-sensitizing agents and thiazolidinediones), becomes suitable when lifestyle modifications and switching therapy are ineffective or not applicable.
在感染人类免疫缺陷病毒（HIV）的患者中，使用新型强效蛋白酶抑制剂类抗逆转录病毒疗法越来越多地与心血管危险因素相关联，这些因素包括高脂血症、脂肪重新分布综合征、胰岛素抵抗和糖尿病。高效抗逆转录病毒疗法（HAART）在临床实践中的引入显著改变了HIV疾病的自然病程，使预期寿命显著延长，而脂质和葡萄糖代谢异常的长期存在预计会对HIV感染患者的长期预后和结局产生重大影响。预测模型、替代标志物和硬性心血管终点表明，接受HAART的HIV感染受试者心血管疾病的发病率增加，尽管心血管并发症的绝对风险仍然较低，而且必须与联合抗逆转录病毒疗法带来的明显病毒学、免疫学和临床益处相权衡。然而，对于HIV阳性个体，尤其是在开始或改变抗逆转录病毒治疗后，应定期进行心血管风险评估。适当的生活方式措施（包括戒烟、饮食改变和有氧运动）是关键要点，虽然维持病毒血症控制应是治疗的主要目标，但可以考虑更换HAART方案。当生活方式改变和更换治疗方案无效或不适用时，对血脂异常（通常使用他汀类药物和贝特类药物）和高血糖（使用胰岛素增敏剂和噻唑烷二酮类药物）进行药物治疗是合适的。
