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Current pharmacotherapy for the treatment of dyslipidemia associated with HIV infection

Anna Gebhardt1, Carl J Fichtenbaum1

  • 1Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine , Cincinnati , OH , USA.

Expert Opinion on Pharmacotherapy
|June 25, 2019
PubMed

Insights

Persons with human immunodeficiency virus (PWH) face higher risks of cardiovascular disease due to dyslipidemia. Lipid-lowering therapies, particularly statins, are crucial for managing atherosclerotic cardiovascular disease (ASCVD) risk in PWH.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Pharmacology

Background:

  • Cardiovascular disease (CVD) is a leading cause of illness and death in people with human immunodeficiency virus (PWH).
  • PWH have a greater risk of atherosclerotic cardiovascular disease (ASCVD) compared to HIV-uninfected individuals.
  • Dyslipidemia, driven by chronic inflammation from HIV, is a key factor in ASCVD development among PWH.

Purpose of the Study:

  • To review current evidence on lipid-lowering therapies for PWH.
  • To examine the use, drug interactions, safety, and efficacy of statins in PWH.
  • To explore alternative lipid-lowering agents, including omega-3 fatty acids, fibrates, niacin, ezetimibe, and PCSK-9 inhibitors.

Main Methods:

  • Literature review of studies on lipid-lowering therapy in PWH.
  • Analysis of data on statin use, including interactions, safety, and efficacy.
  • Review of evidence for alternative lipid-lowering agents.

Main Results:

  • Dyslipidemia is prevalent in PWH, increasing ASCVD risk.
  • Lipid-lowering therapy can reduce ASCVD risk, though PWH-specific clinical trials are limited.
  • Statin therapy is the primary approach for ASCVD primary prevention, but optimal initiation timing in PWH remains undetermined.

Conclusions:

  • Lipid-lowering therapy is essential for managing ASCVD risk in PWH.
  • While statins are foundational, further research is needed on their optimal use and alternative agents in this population.
  • Upcoming trials, such as REPRIEVE, are expected to provide crucial insights into the best lipid-lowering strategies for PWH.

Keywords:
DyslipidemiaHIVHMG-CoA reductase inhibitorsPCSK-9 inhibitorsstatins

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