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HIV infection and lipids
Anjly Jain1, Trupti Kolvekar, Devaki R Nair
1Department of Clinical Biochemistry, Royal Free London NHS Foundation Trust, London, UK.
Insights
Dyslipidemia significantly increases cardiovascular disease (CVD) risk in HIV patients due to infection and antiretroviral therapy (ART). Early CVD risk assessment and lipid-friendly ART are crucial for managing HIV-associated CVD.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- HIV infection and antiretroviral therapy (ART) contribute to dyslipidemia and cardiovascular disease (CVD) risk.
- Older ART regimens were associated with higher lipid abnormalities, while newer therapies are more lipid-friendly.
- Increased life expectancy in HIV patients leads to a rise in non-HIV related complications like CVD.
Purpose of the Study:
- To review the role of dyslipidemia in CVD among HIV-infected patients.
- To discuss traditional CVD risk factors, HIV-specific risks, and ART-induced dyslipidemia.
Main Methods:
- Literature review and expert commentary on dyslipidemia in HIV.
- Analysis of risk factors contributing to CVD in the HIV population.
- Discussion of current and emerging ART strategies and their lipid impact.
Main Results:
- HIV patients face complex CVD risk due to infection and ART.
- Advancements in ART have improved life expectancy but shifted mortality towards non-HIV complications like CVD.
- Ongoing studies are investigating interventions for dyslipidemia in HIV.
Conclusions:
- All HIV patients require CVD risk assessment before initiating ART.
- Selection of lipid-friendly ART regimens is recommended.
- Intervention for associated CVD risk factors, including lipids, hypertension, and smoking, is essential.
Purpose Of Review:
We comment on the role of dyslipidaemia in cardiovascular disease (CVD) in HIV-infected patients. We have discussed various risk factors, including traditional CVD risk factors, HIV-related risk factors and antiretroviral therapy (ART)-induced dyslipidaemia.
Recent Findings:
HIV-infected individuals are prone to lipid and lipoprotein abnormalities as a result of the infection itself and the effect of ART. The older drugs used for the treatment of HIV were associated with an increased risk of these abnormalities. New therapies used to treat HIV are lipid friendly. Calculating CVD risk in the HIV population is complex due to the infection itself and the ART-related factors. The advancement in ART has helped to increase the life expectancy of HIV patients. As a result, a growing number of patients die of non-HIV related complications such as CVD, hepatic and renal disease. Outcome studies with intervention for dyslipidaemia in HIV are underway.
Summary:
The implications of the above findings suggest that all patients with HIV should undergo a CVD risk assessment before starting ART. Appropriate lipid-friendly ART regimen should be initiated along with intervention for associated CVD risk factors (e.g. lipids, hypertension and smoking).
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