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Published on: October 12, 2017
Treatment of dyslipidemia in HIV-infected patients
Rajagopal V Sekhar1, Ashok Balasubramanyam
1Translational Metabolism Unit, Diabetes and Endocrinology Research Center, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX 77030-2600, USA.
Insights
Managing dyslipidemia in HIV patients is complex. This review details the pathophysiology and evidence-based strategies, including lifestyle changes and pharmacotherapy, for effective treatment.
Area of Science:
- Cardiology
- Endocrinology
- Infectious Diseases
Background:
- HIV-infected individuals face elevated risks of dyslipidemia, insulin resistance, and cardiovascular disease.
- Current therapeutic strategies for these conditions are often complex, debated, and inconsistently effective.
Purpose of the Study:
- To provide a comprehensive overview of the pathophysiology of lipid abnormalities in HIV.
- To outline evidence-based and expert-opinion-driven therapeutic approaches for managing dyslipidemia in HIV patients.
Main Methods:
- Discussion of the pathophysiology of altered lipid profiles (triglycerides, LDL-C, HDL-C) and insulin resistance in HIV.
- Review of lifestyle interventions, conventional pharmacotherapy (statins, fibrates, niacin, thiazolidinediones), and novel treatments (omega fatty acids, acipimox, growth hormone, leptin).
Main Results:
- A thorough understanding of the underlying mechanisms driving lipid abnormalities in HIV.
- A rational, evidence-based framework for the therapeutic management of dyslipidemia in this population.
Conclusions:
- Treating dyslipidemia in HIV patients presents significant challenges, including potential drug interactions.
- Effective management necessitates a deep grasp of pathophysiology and therapeutic principles, integrating lifestyle modifications and appropriate pharmacological agents.
Importance Of The Field:
Patients infected with HIV are at high risk for dyslipidemia, insulin resistance and cardiovascular disease. Therapies to reverse these risks are complex, sometimes controversial, and not uniformly effective.
Areas Covered In This Review:
Pathophysiology of the lipid abnormalities in HIV is discussed, including the causes of alterations in triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and insulin resistance. We discuss the therapy of dyslipidemia in HIV using a combination of available clinical evidence and expert opinion based on extensive clinical experience, with discussions of lifestyle intervention and diet, conventional pharmacotherapy with lipid-lowering medications including statins, fibrates, niacin and thiazolidinediones for dyslipidemia, and newer therapeutic approaches including omega fatty acids, acipimox, growth hormone and leptin.
What The Reader Will Gain:
A detailed understanding of the pathophysiology and rational or evidence-based approach to therapy of lipid abnormalities in patients infected with HIV.
Take Home Message:
Treatment of dyslipidemia in patients with HIV is challenging and complicated by the risk of drug interactions. Appropriate therapy requires a sound understanding of pathophysiology and the principles of pharmacological and nonpharmacological therapeutic interventions. An evidence-based approach that combines lifestyle changes and drugs that are both safe and effective, singly and in combination, is described.
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