HIV Infection and Primary Prevention of Cardiovascular Disease: Lights and Shadows in the HAART Era

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• 作者：Flavia Ballocca^a ; ¹ ; Sebastiano Gili^a ; ¹ ; Fabrizio D&rsquo ; Ascenzo^a ; ^{fabrizio.dascenzo@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; ; Walter Grosso Marra^a ; Margherita Cannillo^a ; Andrea Calcagno^b ; Stefano Bonora^b ; Andreas Flammer^c ; John Coppola^d ; Claudio Moretti^a ; Fiorenzo Gaita^a
• 关键词：ARV ; Antiretroviral ; ASCVD ; Atherosclerotic cardiovascular disease ; CHD ; Coronary heart disease ; CRP ; C-reactive protein ; CV ; Cardiovascular ; CVD ; Cardiovascular disease ; CYP ; Cytochrome ; D ; A ; D ; Data Collection on Adverse Effects of Anti-HIV Drugs ; FRS ; Framingham Risk Score ; GLUT ; Glucose transporter ; HAART ; Highly active antiretroviral therapy ; HDL-C ; High-density lipoprotein cholesterol ; hs-CRP ; Highly-sensitive C-reactive protein ; HTN ; Hypertension ; IL ; Interleukin ; LDL-C ; Low-density lipopr
• 刊名：Progress in Cardiovascular Diseases
• 出版年：2016
• 出版时间：March-April 2016
• 年：2016
• 卷：58
• 期：5
• 页码：565-576
• 全文大小：977 K

文摘

With the progressive increase in life-expectancy of human immunodeficiency virus (HIV)-positive patients in the “highly active antiretroviral therapy” (HAART) era, co-morbidities, particularly cardiovascular (CV) diseases (CVD) are emerging as an important concern. The pathophysiology of CVD in this population is complex, due to the interaction of classical CV risk factors, viral infection and the effects of antiretroviral therapy (ARV). The role of ARV drugs in HIV is double edged. While these drugs reduce systemic inflammation, an important factor in CV development, they may at the same time be proatherogenic by inducing dyslipidemia, body fat redistribution and insulin resistance. In these patients primary prevention is challenging, considering the lower median age at which acute coronary syndromes occur. Furthermore prevention is still limited by the lack of robust evidence-based, HIV-specific recommendations. Therefore we performed a comprehensive evaluation of the literature to analyze current knowledge on CVD prevalence in HIV-infected patients, traditional and HIV-specific risk factors and risk stratification, and to summarize the recommendations for primary prevention of CVD in this HIV population.