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Published on: October 12, 2017
Approach to dyslipidemia, lipodystrophy, and cardiovascular risk in patients with HIV infection
1Touro University College of Osteopathic Medicine, 1310 Club Drive, Vallejo, CA 94592, USA. greg.troll@tu.edu
Insights
People with HIV often have lipid disorders and cardiovascular risks. This review discusses HIV treatment impacts on metabolic and cardiovascular health, suggesting proactive screening and management strategies.
Area of Science:
- Infectious Diseases
- Cardiology
- Endocrinology
Background:
- Significant prevalence of lipid disorders and cardiovascular risk factors in people living with HIV (20%-80%).
- HIV infection and antiretroviral therapy (ART) are associated with metabolic and cardiovascular complications.
Purpose of the Study:
- To review HIV-associated metabolic and cardiovascular concerns.
- To discuss emerging pathophysiology and its impact on ART selection and management.
- To suggest screening and preventive strategies for cardiovascular risk in HIV patients.
Main Methods:
- Review of current literature on HIV, metabolic disorders, and cardiovascular disease.
- Analysis of the impact of antiretroviral treatment (ART) on metabolic and cardiovascular health.
- Discussion of emerging hypotheses on pathophysiology and management strategies.
Main Results:
- HIV and ART are linked to dyslipidemias, lipodystrophy, endothelial dysfunction, and insulin resistance.
- Understanding pathophysiology is crucial for selecting ART strategies and preventive measures.
- Screening for cardiovascular risk is recommended before initiating ART and during ongoing care.
Conclusions:
- Proactive screening and management of cardiovascular risk are essential for people with HIV.
- ART selection should consider potential metabolic and cardiovascular adverse effects.
- Multifaceted approaches including pharmacotherapy and lifestyle interventions are needed to mitigate risks.
Abstract:
There is a significant prevalence (20%-80% depending on the population and the study) of lipid disorders and other cardiovascular risk factors in people living with HIV infection. This review focuses on HIV and HIV treatment-associated metabolic and cardiovascular concerns, including dyslipidemias, lipodystrophy syndromes, endothelial dysfunctions, and associated metabolic events such as insulin resistance. Emerging hypotheses of the underlying pathophysiology of these issues, with impact on selection of specific antiretroviral treatment (ART) strategies, therapy, and preventive approaches to decreasing cardiovascular risk and other problems associated with these syndromes are discussed. Screening for cardiovascular risk as part of the decision of starting antiretroviral therapy, and during care of patients with HIV regardless of ART therapy status, is suggested with particular areas of focus. Statins, other hyperlipidemic therapies, treatment for specific problems arising due to lipodystrophy, and implications on ART selection to avoid drug interactions and adverse effects are also discussed.
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