Use of direct renin inhibitor in an HIV positive subject

Drugs acting on the renin angiotensin system (RAS), such as angiotensin converting enzyme (ACE) inhibitors and sartans, have been used for hypertension treatment in the HIV-negative population. These drugs reduce hypertension related cardiovascular diseases such as renal impairment in the general population. Limited data show similar findings also in the HIV-positive population. A new drug called aliskiren has recently become available on the market: it is able to block the RAS by a different mechanism acting as direct renin inhibitor. No data are available about the use of aliskiren in HIV-positive patients.

A 61-year-old HIV-infected Caucasian male (CDC C3) patient with hypertension for ten years and cardiovascular complications took carvedilol 25 mg twice a day, plus daily administration of irbesartan 300 mg, hydroclorotiazide 25 mg, doxazosin 4 mg, lacidipine 6 mg, and simvastatin 40 mg. He took AZT+ 3TC + RAL with a good profile on HIV replication and immunological parameters. We found a non-optimal blood pressure value and decided to start aliskiren 150 mg a day to improve blood pressure control. After one month blood pressure control and proteinuria improved. In our case the use of low doses of aliskiren appeared to improve the level of blood pressure, although five antihypertensive agents had already been used on the patient. Finally, although aliskiren would appear to have no direct effect on viro-immunological parameters and does not seem to interfere with cART, further studies are warranted in this context.