Martínez Chamorro Esteban
Servicio de Infecciones, Hospital Clínic-Institut d'Investigaciones Biomèdiques August Pi i Sunyer, Universidad de Barcelona, España.
Enferm Infecc Microbiol Clin. 2008 Dec;26 Suppl 17:34-40. doi: 10.1016/S0213-005X(08)76618-7.
It is currently known that exposure to antiretroviral treatment, particularly to the classic protease inhibitors, is associated with an increased risk of suffering from cardiovascular disease, although stopping antiretroviral treatment can cause an even greater risk. Recommendations have been made on how to deal with dyslipaemia and cardiovascular risk in seropositive patients. These recommendations are similar to those for the general population, but include the particular feature of considering including benign treatment with lipids wherever possible. Atazanavir has different characteristics from other protease inhibitors as regards its effects on adipose tissue and metabolism in general. Atazanavir is not associated with increases in total cholesterol, LDL-cholesterol or triglycerides as with other PI in initial, rescue or simplification therapy. The results of in vitro studies and clinical studies are clear and convincing. These characteristics give it a particular role that is very attractive when deciding the most suitable antiretroviral treatment for a proportion of HIV-infected patients in whom the reduction in cardiovascular risk is seen as a priority.
目前已知，接受抗逆转录病毒治疗，尤其是经典蛋白酶抑制剂治疗，会增加患心血管疾病的风险，尽管停止抗逆转录病毒治疗可能会带来更大的风险。针对血清反应阳性患者的血脂异常和心血管风险处理，已有相关建议。这些建议与针对普通人群的建议相似，但包括尽可能考虑采用脂质良性治疗这一特殊特征。阿扎那韦在对脂肪组织和整体代谢的影响方面，与其他蛋白酶抑制剂具有不同的特性。在初始、挽救或简化治疗中，阿扎那韦不像其他蛋白酶抑制剂那样会导致总胆固醇、低密度脂蛋白胆固醇或甘油三酯升高。体外研究和临床研究的结果清晰且令人信服。在为一部分将降低心血管风险视为首要任务的HIV感染患者确定最合适的抗逆转录病毒治疗方案时，这些特性赋予了阿扎那韦一个非常有吸引力的特殊作用。
