The James Cook University Hospital, Division of acute Medicine, Middlesbrough TS4 3BW, UK.
Expert Opin Pharmacother. 2012 Sep;13(13):1901-9. doi: 10.1517/14656566.2012.706604. Epub 2012 Jul 7.
Statin therapy is widely used across the globe for the treatment and prevention of cardiovascular disease (CVD). It is well established that statin therapy is associated with significant decrease in low-density lipoprotein cholesterol (LDL-C) and plasma cholesterol levels. HIV-dyslipidemia is a common problem with extensive use of combination antiretroviral therapy (CART), and is associated with an increase in incidence of cardiovascular disease (CVD), resulting in hospital admission and surgery throughout the western healthcare systems.
This review describes the effectiveness and safety of statins in the treatment of HIV-dyslipidemia. Medline was searched for different statins as treatment for HIV-dyslipidemia.
Dyslipidemia in patients with HIV is different from the normal population, due to the fact that HIV treatment may not only cause dyslipidemia, but may also interact with lipid lowering medication. Statin-unresponsive HIV-dyslipidemia can be treated with the addition of ezetimibe, fenofibrate, fish oil and niacin. Current guidelines recommend the use of pravastatin and atorvastatin as first-line therapy, whereas European guidelines include rosuvastatin. There is an urgent need to confirm whether the use of statins in HIV-dyslipidemia is associated with an increase in the incidence of diabetes; this is significant because HIV patients are known to be insulin-resistant. HIV is also associated with Non-alcoholic Fatty Liver Disease (NAFLD), a condition known to be associated with insulin resistance. Further clinical trials are urgently needed to assess the impact of statins on CVD in HIV patients, and future challenges for researchers in this area are enormous.
他汀类药物治疗在全球范围内广泛用于心血管疾病（CVD）的治疗和预防。他汀类药物治疗与低密度脂蛋白胆固醇（LDL-C）和血浆胆固醇水平的显著降低有关，这一点已得到充分证实。HIV 血脂异常是联合抗逆转录病毒疗法（CART）广泛应用的一个常见问题，与心血管疾病（CVD）发病率的增加有关，导致整个西方医疗保健系统的住院和手术增加。
本综述描述了他汀类药物治疗 HIV 血脂异常的有效性和安全性。检索了 Medline 上不同的他汀类药物作为治疗 HIV 血脂异常的药物。
由于 HIV 治疗不仅可能导致血脂异常，而且可能与降脂药物相互作用，因此 HIV 患者的血脂异常与普通人群不同。对于他汀类药物反应不佳的 HIV 血脂异常，可以添加依折麦布、非诺贝特、鱼油和烟酸进行治疗。目前的指南建议使用普伐他汀和阿托伐他汀作为一线治疗药物，而欧洲指南则包括瑞舒伐他汀。迫切需要确认 HIV 血脂异常中使用他汀类药物是否与糖尿病发病率的增加有关；这很重要，因为众所周知，HIV 患者对胰岛素有抵抗力。HIV 还与非酒精性脂肪性肝病（NAFLD）有关，这种疾病已知与胰岛素抵抗有关。迫切需要进一步的临床试验来评估他汀类药物对 HIV 患者 CVD 的影响，该领域研究人员未来面临的挑战是巨大的。
