Jain Anjly, Kolvekar Trupti, Nair Devaki R
Department of Clinical Biochemistry, Royal Free London NHS Foundation Trust, London, UK.
Curr Opin Cardiol. 2018 Jul;33(4):429-435. doi: 10.1097/HCO.0000000000000520.
We comment on the role of dyslipidaemia in cardiovascular disease (CVD) in HIV-infected patients. We have discussed various risk factors, including traditional CVD risk factors, HIV-related risk factors and antiretroviral therapy (ART)-induced dyslipidaemia.
HIV-infected individuals are prone to lipid and lipoprotein abnormalities as a result of the infection itself and the effect of ART. The older drugs used for the treatment of HIV were associated with an increased risk of these abnormalities. New therapies used to treat HIV are lipid friendly. Calculating CVD risk in the HIV population is complex due to the infection itself and the ART-related factors. The advancement in ART has helped to increase the life expectancy of HIV patients. As a result, a growing number of patients die of non-HIV related complications such as CVD, hepatic and renal disease. Outcome studies with intervention for dyslipidaemia in HIV are underway.
The implications of the above findings suggest that all patients with HIV should undergo a CVD risk assessment before starting ART. Appropriate lipid-friendly ART regimen should be initiated along with intervention for associated CVD risk factors (e.g. lipids, hypertension and smoking).
我们对血脂异常在HIV感染患者心血管疾病（CVD）中的作用进行评论。我们讨论了各种危险因素，包括传统的CVD危险因素、HIV相关危险因素以及抗逆转录病毒疗法（ART）引起的血脂异常。
由于感染本身以及ART的影响，HIV感染者容易出现脂质和脂蛋白异常。用于治疗HIV的旧药物与这些异常风险增加有关。用于治疗HIV的新疗法对脂质友好。由于感染本身和与ART相关的因素，计算HIV人群的CVD风险很复杂。ART的进步有助于提高HIV患者的预期寿命。因此，越来越多的患者死于非HIV相关并发症，如CVD、肝病和肾病。针对HIV血脂异常干预的结局研究正在进行中。
上述发现表明，所有HIV患者在开始ART之前都应进行CVD风险评估。应启动适当的对脂质友好的ART方案，并对相关的CVD危险因素（如血脂、高血压和吸烟）进行干预。
