Gazzaniga Gianluca, Ridolfi Marco, Lazzaro Alessandro, Brogi Tommaso, Pignatelli Pasquale, Pastori Daniele, Mezzaroma Ivano
Department of General Surgery and Surgical Specialty Paride Stefanini, Sapienza University of Rome, Rome, Italy; Department of Medical Biotechnology and Translational Medicine, Postgraduate School of Clinical Pharmacology and Toxicology, Università degli Studi di Milano, Milan, Italy.
Department of Internal Medicine, Endocrine-Metabolic Sciences and Infectious Diseases, AOU Policlinico Umberto I, Rome, Italy.
Nutr Metab Cardiovasc Dis. 2025 Oct;35(10):104110. doi: 10.1016/j.numecd.2025.104110. Epub 2025 May 3.
Advances in antiretroviral therapy have transformed HIV-1 infection into a chronic condition, enabling people living with HIV-1 (PWH) to achieve life expectancies comparable to those of the uninfected population. Consequently, a range of co-morbidities, particularly an increased incidence of cardiovascular events, has becoming more evident. Among these, dyslipidemia stands out as a significant risk factor with a multifactorial pathogenesis. The aim of this narrative review is to highlight the multifactorial origins of dyslipidemia in PWH, to provide an overview of drug interactions between statins and antiretroviral therapy, and examine the unique anti-inflammatory and immunomodulatory properties of statins in this context.
Some studies indicate a reduction of mortality and cardiovascular risk in PWH treated with statins. However, the benefit of statin therapy is variable and seems to be dependent on HIV-1 length exposure and type of antiretroviral drugs and seems to be lower in individuals without comorbidities or additional risk factors. Statins are often underdosed for the perceived risk of drug interactions. Beyond their lipid-lowering effects, statins exert additional benefits, including anti-inflammatory and immunomodulatory actions on vascular tissues, monocyte-macrophages, and lymphocytes. These effects have sparked interest in their potential applications beyond dyslipidemia treatment.
Statins may provide a clinical benefit in PWH by lowering LDL cholesterol and modulating immunity and inflammation. However, there is a clinical need for HIV-1-specific LDL cholesterol targets given the excess cardiovascular risk in this population, as well as for the identification of high-risk subgroups that may benefit most from statin treatment.
抗逆转录病毒疗法的进展已将HIV-1感染转变为一种慢性病，使HIV-1感染者（PWH）的预期寿命能够与未感染者相当。因此，一系列合并症，尤其是心血管事件发生率的增加，变得更加明显。其中，血脂异常作为一种具有多因素发病机制的重要危险因素而突出。本叙述性综述的目的是强调PWH血脂异常的多因素起源，概述他汀类药物与抗逆转录病毒疗法之间的药物相互作用，并在此背景下研究他汀类药物独特的抗炎和免疫调节特性。
一些研究表明，接受他汀类药物治疗的PWH的死亡率和心血管风险有所降低。然而，他汀类药物治疗的益处是可变的，似乎取决于HIV-1暴露时长和抗逆转录病毒药物的类型，并且在没有合并症或其他危险因素的个体中似乎较低。由于存在药物相互作用的潜在风险，他汀类药物的剂量往往不足。除了降脂作用外，他汀类药物还具有其他益处，包括对血管组织、单核细胞-巨噬细胞和淋巴细胞的抗炎和免疫调节作用。这些作用引发了人们对其在血脂异常治疗之外潜在应用的兴趣。
他汀类药物可能通过降低低密度脂蛋白胆固醇以及调节免疫和炎症为PWH带来临床益处。然而，鉴于该人群心血管风险过高，临床上需要针对HIV-1制定特定的低密度脂蛋白胆固醇目标，同时也需要确定可能从他汀类药物治疗中获益最大的高危亚组。
