aUniversity of Ottawa Heart Institute bThe University of Ottawa, Ottawa, Ontario, Canada.
Curr Opin Cardiol. 2014 Mar;29(2):174-9. doi: 10.1097/HCO.0000000000000041.
Since the advent of highly active antiretroviral treatment, accelerated atherosclerosis resulting in coronary artery disease (CAD) has become an area of increasing concern among patients infected with HIV. As CAD has replaced myocarditis and opportunistic infection as the most common cause of heart failure in this population, it is necessary to re-evaluate the specific risks of cardiovascular disease in HIV-infected patients taking into consideration the processes driving atherogenesis.
Recent data illustrating that atazanavir is not associated with an increased risk of CAD argue against a class-wide association of protease inhibitors in HIV treatment and adverse cardiovascular outcomes. C-C chemokine receptor-type 5 has been identified as a potential target for pharmacological therapy to manage the process of atherosclerosis while simultaneously having an antiretroviral effect. Additionally, as the use of statins has recently been associated with new-onset diabetes in the general population, further investigation of this risk in HIV-infected patients is necessary.
HIV-infected patients have an increased risk of CAD and subsequently heart failure. This is likely because of a confluence of several factors including: conventional risk factors, HIV-specific processes driving inflammation, coagulatory pathway and endothelial dysfunction. The benefits of antiretroviral drugs in terms of overall survival rates outweigh the risks of dyslipidemia. The focus of the management of cardiovascular risk remains in the domains of primary and secondary prevention. More accurate risk stratification, which accounts for HIV-specific risk factors, is now increasingly warranted.
自高效抗逆转录病毒治疗问世以来，加速的动脉粥样硬化导致的冠心病（CAD）已成为感染 HIV 患者日益关注的问题。由于 CAD 已取代心肌炎和机会性感染，成为该人群心力衰竭的最常见原因，因此有必要重新评估 HIV 感染患者心血管疾病的具体风险，同时考虑驱动动脉粥样硬化形成的过程。
最近的数据表明，阿扎那韦与 CAD 风险增加无关，这与 HIV 治疗中蛋白酶抑制剂类药物与不良心血管结局之间的关联相矛盾。C-C 趋化因子受体 5 已被确定为一种潜在的药物治疗靶点，可用于管理动脉粥样硬化过程，同时具有抗逆转录病毒作用。此外，由于他汀类药物的使用最近与普通人群中的新发糖尿病相关，因此有必要进一步研究 HIV 感染患者的这种风险。
HIV 感染患者 CAD 和随后心力衰竭的风险增加。这可能是由于多种因素的综合作用，包括：传统危险因素、HIV 特异性炎症驱动因素、凝血途径和内皮功能障碍。抗逆转录病毒药物在总体生存率方面的益处超过了血脂异常的风险。心血管风险管理的重点仍然在一级和二级预防领域。现在越来越需要更准确的风险分层，包括 HIV 特异性风险因素。
