Ritonavir-boosted protease inhibitors, Part 2: cardiac implications of lipid alterations

Ritonavir-boosted protease inhibitor (PI) regimens have provided substantial benefits in the treatment of HIV/AIDS, resulting in improved clinical outcomes. However, treatment toxicities often affect adherence and may influence outcomes. Dyslipidemia is highly prevalent in many patients who receive a boosted PI regimen. The mechanism underlying dyslipidemia is probably multifactorial and may differ among the individual PIs. The prevalence of cardiovascular disease and events appears to be higher in patients treated with boosted PIs, and as long-term survival increases in HIV-infected persons, the long-term effect of dyslipidemia becomes a growing concern. The practitioner must consider the possibility of these adverse effects when choosing the antiretroviral regimen that best suits each patient. Until future studies define the optimal approach, an evaluation of cardiovascular risk factors and treatment of those risk factors according to evidence-based guidelines are warranted.