Guidelines for the prevention of cardiovascular risk in HIV-infected patients treated with antiretroviral drugs

D. Scevola, G. Barbarini, G. Barbaro

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Highly active antiretroviral therapy (HAART) has decreased by two-thirds [1] the lethality of AIDS and opportunistic infections. However, the improved survival of HIV patients receiving HAART has become associated with lipid abnormalities [2-14] that increase cardiovascular morbidity, compromising the patient's quality of life and the efficacy of HAART. AIDS is changing from a "slim disease" to a "lipodystrophic disease" as a consequence of prolonged survival and the direct effect of HAART. The risk of cardiovascular disease in HIV patients is increased two- to threefold by disturbances in fat metabolism. New strategies addressed to prevent and manage such emerging disorders [15, 16] are needed. Moreover, coronary heart disease (CHD) is the leading cause of death and a common cause of morbidity in Western countries. Approximately 14 million Americans have CHD, according to NHANES III data [17]. Annually, about 1.1 million of them experience a heart attack and about 500,000 die from CHD (Fig. 1). The objective proposed by various health authorities for the year 2010 is to reduce CHD. Figure presented. deaths to no more than 51 in 100,000, "enhancing the cardiovascular health and quality of life of all Americans through improvement of medical management, prevention and control of risk factors, and promotion of healthy lifestyle behaviors" [18]. In light of this policy also adopted by the European Union, particular attention must be devoted to HIV-infected individuals,who in the near future could represent an emerging population at a more elevated risk of CHD due to the prolonged life expectancy and/or metabolic disturbances induced by therapy [19-22]. Elevated triglycerides (TG), low-density lipoprotein (LDL) cholesterol, very low-density lipoprotein (VLDL) cholesterol, and reduced levels of high-density lipoprotein (HDL) cholesterol are associated with visceral fat accumulation, peripheral lipodystrophy/lipoatrophy, and CHD. It has been reported that 5%-75% of HIV patients receiving HAART experience a worse lipid metabolism and body fat distribution after 10-12 months of therapy. Our guidelines, based on our own and others' experience [23-28], meet the intervention criteria defined by the American National Cholesterol Education Program (NCEP) [29], including evaluation criteria, diet prescription, drug and exercise treatment - preliminary discussion included in The Pavia Consensus Statement, October 2001 [30, 31] - and the recommendations of the HIV Medicine Association of the Infectious Disease Society of America and the Adult AIDS Clinical Trials Group (AACTG) [32].

Original languageEnglish
Title of host publicationCardiovascular Disease in AIDS
PublisherSpringer Milan
Pages143-153
Number of pages11
ISBN (Print)8847003091, 9788847003095
DOIs
Publication statusPublished - 2005

ASJC Scopus subject areas

  • Medicine(all)

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    Scevola, D., Barbarini, G., & Barbaro, G. (2005). Guidelines for the prevention of cardiovascular risk in HIV-infected patients treated with antiretroviral drugs. In Cardiovascular Disease in AIDS (pp. 143-153). Springer Milan. https://doi.org/10.1007/88-470-0358-X_14