Husain Nazik Elmalaika Os, Ahmed Mohamed H
Department of Pathology, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Khartoum, Sudan.
Department of Medicine, Milton Keynes Hospital, NHS Foundation Trust, Milton Keynes, UK.
HIV AIDS (Auckl). 2014 Dec 17;7:1-10. doi: 10.2147/HIV.S46028. eCollection 2015.
Human immunodeficiency virus (HIV) is a chronic disease associated with dyslipidemia and insulin resistance. In addition, the administration of combination antiretroviral therapy is associated with an increase in the incidence of metabolic risk factors (insulin resistance, lipoatrophy, dyslipidemia, and abnormalities of fat distribution in HIV patients). HIV dyslipidemia is a common problem, and associated with an increase in incidence of cardiovascular disease. Further challenges in the management of HIV dyslipidemia are the presence of diabetes and metabolic syndrome, nonalcoholic fatty liver disease, hypothyroidism, chronic kidney disease, the risk of diabetes associated with statin administration, age and ethnicity, and early menopause in females. Dyslipidemia in patients with HIV is different from the normal population, due to the fact that HIV increases insulin resistance and HIV treatment not only may induce dyslipidemia but also may interact with lipid-lowering medication. The use of all statins (apart from simvastatin and lovastatin) is safe and effective in HIV dyslipidemia, and the addition of ezetimibe, fenofibrate, fish oil, and niacin can be used in statin-unresponsive HIV dyslipidemia. The management of dyslipidemia and cardiovascular disease risks associated with HIV is complex, and a certain number of patients may require management in specialist clinics run by specialist physicians in lipid disorders. Future research is needed to address best strategies in the management of hyperlipidemia with HIV infection.
人类免疫缺陷病毒（HIV）是一种与血脂异常和胰岛素抵抗相关的慢性疾病。此外，联合抗逆转录病毒疗法的应用与代谢危险因素（HIV患者的胰岛素抵抗、脂肪萎缩、血脂异常和脂肪分布异常）的发生率增加有关。HIV血脂异常是一个常见问题，与心血管疾病发生率的增加相关。HIV血脂异常管理中的进一步挑战包括糖尿病和代谢综合征、非酒精性脂肪性肝病、甲状腺功能减退、慢性肾脏病、他汀类药物应用相关的糖尿病风险、年龄和种族以及女性过早绝经。HIV患者的血脂异常与正常人群不同，因为HIV会增加胰岛素抵抗，且HIV治疗不仅可能诱发血脂异常，还可能与降脂药物相互作用。除辛伐他汀和洛伐他汀外，所有他汀类药物在HIV血脂异常中使用都是安全有效的，对于他汀类药物无反应的HIV血脂异常患者可加用依折麦布、非诺贝特、鱼油和烟酸。与HIV相关的血脂异常和心血管疾病风险的管理很复杂，一定数量的患者可能需要在脂质紊乱专科医生开设的专科诊所进行管理。未来需要开展研究以确定HIV感染患者高脂血症管理的最佳策略。
