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EVALUACION DEL RIESGO CARDIOVASCULAR EN PACIENTES HIV POSITIVOS

(especial para SIIC © Derechos reservados)
La enfermedad cardiovascular puede constituirse en una importante complicación de la infección por VIH a mediano y largo plazo.
iriberri9.jpg Autor:
Guillermo enrique Iriberri
Columnista Experto de SIIC

Institución:
Hospital Francisco Javier Muñiz, Unidad de Guardia del Departamento de Urgencias

Artículos publicados por Guillermo enrique Iriberri
Recepción del artículo
12 de Junio, 2006 		Aprobación
26 de Junio, 2006
Primera edición
15 de Septiembre, 2006 		Segunda edición, ampliada y corregida
7 de Junio, 2021

EVALUACION DEL RIESGO CARDIOVASCULAR EN PACIENTES HIV POSITIVOS

Resumen
La terapéutica antirretroviral de gran actividad (TARGA) ha permitido una disminución de la morbimortalidad a corto plazo en aquellos pacientes infectados por VIH. Sin embargo, se ha podido comprobar en ellos la presencia de distintas alteraciones metabólicas, en particular, la de dislipemia. Esto lleva a suponer que la enfermedad cardiovascular puede constituirse en una importante complicación de la infección por VIH a mediano y largo plazo. En esta revisión se pondrá de manifiesto ese riesgo y se darán las bases para un adecuado manejo de la dislipemia, se analizan las mejores estrategias terapéuticas en cuanto a cambios en el estilo de vida, al tratamiento con hipolipemiantes y al ajuste en la TARGA. Se recomendará no realizar ningún cambio en el régimen antirretroviral que pueda comprometer la estabilidad virológica o inmunológica del paciente ya que, el riesgo absoluto de muerte asociado al sida que está fuera de control virológico, es marcadamente mayor que el asociado a la enfermedad cardiovascular. Se hará constar, además, la necesidad de estudios prospectivos que evalúen los efectos del tratamiento de los factores de riesgo cardiovascular que se desarrollen mientras el paciente se halla bajo TARGA y del efecto que producirán los cambios en los regímenes antirretrovirales.

Palabras clave
Riesgo cardiovascular, TARGA, VIH, sida


Artículo completo
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CARDIOVASCULAR RISK IN PATIENTS WITH HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION

Abstract
Highly active antiretroviral therapy (HAART) has been associated with a decrease in the short-term morbidity and mortality in patients with HIV infection. Nevertheless, several metabolic changes, specifically dyslipidemia, are common in them. The preceding leads to a concern that cardiovascular disease may become an important complication of HIV infection in the mid and long-term. This review highlights the risk and gives the basis for the management of dyslipidemia, analyzing the best therapeutic strategy in lifestyle changes, lipid-lowering therapy and HAART switching. The most important recommendation is not to carry out any change in the antiretroviral therapy that could put virologic and immunologic stability at risk, because, absolute death rates from AIDS out of viremic control are higher than rates for cardiovascular disease. Prospective studies evaluating the effects of treatment of cardiovascular risk factors that develop while in HAART and the effects of changes in antiretroviral regimens are needed.

Key words
Cardiovascular risk, HAART, AIDS, HIV

Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Infectología
Relacionadas: Bioquímica, Cardiología, Diagnóstico por Laboratorio, Epidemiología, Medicina Interna, Pediatría



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Enviar correspondencia a:
Guillermo E. Iriberri, Unidad de Guardia del Departamento de Urgencias, Hospital Francisco Javier Muñiz, Av. Federico Lacroze 2277 4º piso B, Buenos Aires, Argentina
Bibliografía del artículo
1. Sepkowitz K. AIDS-the first 20 years. N Engl J Med 2001; 344:1764-1772.
2. Palella F, Delaney K, Moorman A, et al. Declining morbidity and mortality among patients with advanced human inmunodeficiency virus infection. N Engl J Med 1998; 338:853-60.
3. Mocroft A, et al. Decline in the AIDS and death rates in the EuoAIDS study: an observational study. Lancet 2003; 362:22-29.
4. Lundgren J, Moyle G. Cardiovascular risk asssessment and management in patients with HIV. 2005. Disponible en: www.mesdcape.com/viewarticle/506157.
5. Stein J. Managing cardiovascular risk in patients with HIV infection. J Acquir Immune Def Syndr 2005; 38(2):115-123.
6. Palella F, Deloria-Knoll M, Chmiel J, et al. Survival benefit of initiating antiretroviral therapy in HIV-infected persons in different CD4+ cell strata. Ann Intern Med 2003; 138:620-626.
7. Bozzette S, Ake C, Tam H, et al. Cardiovascular and cerebrovascular events in patients treated for human immunodeficiency virus infections. N Engl J Med 2003; 348:702-710.
8. Friis-MollerN, Weber R, Reiss P, et al. Cardiovascular disease risk factors in HIV patients-association with antiretroviral therapy. Results from the DAD study. AIDS 2003; 17:1179-1193.
9. Shelton D. Changing demographics in HIV infections. 2000. Disponible en: www.ama-assn.org/amednews/2000/10/23/hisa1023.htm.
10. Carr A, Samaras K, Burton S, et al. A syndrome of peripheral lipodystrophy, hiperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors. AIDS 1998; 12(Suppl):F51-F58.
11. Dube M, Sattler F. Metabolic complications of antiretroviral therapies. AIDS Clin Care 1998; 10:41-44.
12. Sorelle R. Vascular and lipid syndromes in selected HIV-infected patients. Circulation 1998; 98:829-830.
13. Tabib A, Greenland T, Mercier I, et al. Coronary lesions in young HIV-positive subjects at necropsy. Lancet 1992; 340-730.
14. Constans J, Marchand J-M, Conn C, et al. Asymptomatic atherosclerosis in HIV-positive patients a case-control ultrasound study. Ann Med 1995; 27:683-685.
15. Gallet B, Pulik M, Genet, et al. Vascular complications associated with use of HIV proteasa inhibitors. Lancet 1998; 351:1958-1959.
16. Henry K, Melroe H, Huebsch J, et al. Severe premature coronary artery disease with protease inhibitors. Lancet 1998; 351:1328.
17. Grunfeld C, Kotler DP, Hamadeh R, Tierney A, Wang J, Pierson RN. Hypertriglyceridemia in the acquired immunodeficiency syndrome. Am J Med 1989; 86:27-31.
18. Grunfeld C, Pang M, Doerrier W, et al. Lipids, lipoproteins, triglyceride clearance, and cytokines in human immunodeficiency virus infection and the acquired immunodeficiency syndrome. J Clin Endocr Metab 1992; 74:1045-1052.
19. Shor-Posner G, Bast A, Lu Y, et al. Hypocholesterolemia is associated with immune dysfunction in early human immunodeficiency virus-1 infection. Am J Med 1993; 94:515-519.
20. Chironi G, Escaut L, Gariepy J, et al. Brief report carotid intima-media thickness in heavily pretreated HIV-infected patients. J Acquir Immune Defic Syndr 2003; 32:490-493.
21. Depairo M, Chessex S, Sudre P, et al. Premature atherosclerosis in HIV-infected individuals-focus on protease inhibitor therapy. AIDS 2001; 15:329-334.
22. Maggi P, Serio G, Epifani G, et al. Premature lesions of the carotid vessels en HIV-1 infected patients treated with protease inhibitors. AIDS 2000; 14 (Suppl):F123-128.
23. Meng Q, Lima J, Lai H, et al. Coronary artery calcification, atherogenic lipid changes, and increased erythrocyte volume in black injection drug users infected with human immunodeficiency virus-1 treated with proteasa inhibitors. Am Heart J 2002; 144:642-648.
24. Mercie P, Thiebaut R, Lavignotte V, et al. Evaluation of cardiovascular risk factors in HIV-1 infected patients using carotid intima-media thickness measurement. Ann Med 2002; 33:55-63.
25. Seminari E, Pan A, Voltini G, et al. Assessment of atherosclerosis using carotid ultrasonography in a cohort of HIV-positive patients treated with protease inhibitors. Atherosclerosis 2002;162:433-438.
26. Hsue P, Lo J, Franklin A, et al. Increased atherosclerotic progression in patients with HIV: the role of traditional and immunologic risk factors. Presentado en la 10th Conference on Retroviruses and Opportunistic Infections; 2003; Boston, USA.
27. Dube M, Shanker S, Vanderluitgaren J, et al. Effect of indinavir (IDV) monotherapy on endothelial function in men without HIV infection. Presentado en la Ninth Conference on Retroviruses and Opportunistic Infections; 2002; Seattle, USA.
28. Monsuez J, Dufaux J, Jittecoq D, et al. Reduced reactive hyperemia in HIV-infected patients. J Acquir Immune Defic Syndr 2000; 25:434-442.
29. Nolan D, Watts G, Herrmann S, et al. Endothelial function in HIV-infected patients receiving protease inhibitor therapy:does immune competence affect cardiovascular risk? QJM 2003; 96:825-832.
30. Stein J, Klein M, Bellehumeur J, et al. Use of human immunodeficiency virus-1 protease inhibitors is associated with atherogenic lipoprotein changes and endothelial dysfunction. Circulation 2001; 104:257-262.
31. Friis-Moller N, Sabin C, Weber R, et al. Combination antiretroviral therapy and the risk of myocardial infarction. N Engl J Med 2003; 349:1993-2003.
32. El-Sadr W, Reiss P, DeWit S, et al on behalf of the DAD Study Group. Relationship between prolonged exposure to combination ART and myocardial infarction:effect of sex, age, and lipid changes. Programa y resúmenes de la 12th Conference on Retroviruses and Opportunistic Infections; February 22-25, 2005; Boston, Massachusetts, USA. Abstract 42.
33. Parruti G, Manzoli L, Di Iorio G, et al. Plasma homocysteine levels in an Italian cohort of HIV infected patients. Programa y resúmenes de la 3rd IAS Conference on HIV. Pathogenesis and Treatment; July 24-27, 2005; Río de Janeiro, Brazil. Abstract TuPe2.3C24.
34. Law MG, D,Armiño Monforte A, Friis-Moller N, et al. Cardio and Cerebrovascular events and predicted rates of myocardial infarction in the DAD Study. Programa y resúmenes de la 11th Conference on Retroviruses and Opportunistic Infections; February 8-11, 2004; San Francisco, California, USA. Abstract 737.
35. Dube M, Stein J, Aberg J, et al. Guidelines for the evaluation and management of dyslipidemia in human immunodeficiency virus (HIV)-infected adults receiving antiretroviral therapy:recommendations of the HIV Medical Association of the Infectious Disease Society of America and the Adult AIDS Clinical Trials Group. Clin Infect Dis 2003; 37:613-627.
36. Executive Summary. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285:2486-2497.
37. Lee I. Physical activity in women:how much is good enough? JAMA 2003; 290:1377-1379.
38. Williams P. Physical fitness and activity as separate heart disease risk factors: a meta-analysis. Med Sci Sports Exerc 2001; 33:754-761.
39. Hu F, Willett W. Optimal diets for prevention of coronary heart disease. JAMA 2002; 288:2569-2578.
40. De Lorgeril M, Salen P, Martin J, et al. Mediterranean dietary pattern in a randomized trial: prolonged survival and possible reduced cancer rate. Arch Intern Med 1998; 158:1181-1187.
41. De Lorgeril M, Salen P, Martin J, et al. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999; 99:779-785.
42. Singh R, Dubnov G, Niaz M, et al. Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean Diet Heart Study): a randomised single-blind trial. Lancet 2002; 360:1455-1461.
43. Knowler W, Barrett-Connor E, Fowler S, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346:393-403.
44. Tuomilehto J, Lindstrom J, Eriksson J, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344:1343-1350.
45. Kaletra TM (lopinavir/ritonavir). Prescribing Information. Abbott Laboratories; 2001.
46. Viracept TM (nelfinavir mesylate). Prescribing Information. Agouron Pharmaceuticals, Inc; 2001.
47. Crixivan TM (indinavir sulfate) Prescribing Information. Merck & Co. Inc; 2000.
48. Carr RA, Andre AK, Bertz RJ, et al. Concomintant administration of ABT-378/ritonavir (ABT-378/r) results in clinically important pharmacokinetic (PK) interaction with atorvastatin (ATO) but not pravastatin (PRA). (Abstract 1644). 40th Interscience Conference on Antimicrobial Agents and Chemotherapy; September 17-19, 2000;Toronto, Canada.
49. Hui D. Effects of HIV protease inhibitor therapy on lipid metabolism. Prog Lipid Res 2003; 42:81-92.
50. Aberg J, Zackin R, Evans S, et al. A prospective, multicenter, randomized trial comparing the efficacy and safety of fenofibrate versus pravastatin in HIV-infected subjects with lipid abnormalities: ACTG 5087. Presentado en la XIV International AIDS Conference; 2002; Barcelona.
51. Ballantyne C, Davidson M. Possible differences between fibrates in pharmacokinetic interactions with statins. Arch Intern Med 2003; 163:2394-2395.
52. Fisac C, Fumero E, Crespo M, et al. Metabolic and body composition changes in patients switching from a protease inhibitor-containing regimen to abacavir (ABC), efavirenz (EFV) or nevirapine (NVP). Twelve-month results of a randomized study (LIPNEFA). Programa y resúmenes de la 14th International AIDS Conference; July 7-12, 2002; Barcelona, Spain. Abstract ThPeB7354.
53. Johnson M, DeJesus E, Grinsztejn B, et al. Comparison of atazanavir (ATV) with ritonavir or saquinavir vs lopinavir/ritonavir in patients with multiple virologic failures:BMS AI424-045 96 Week Results. Programa y resúmenes del 7th International Congress on Drug Therapy in HIV Infection; November 14-18, 2004; Glasgow, United Kingdom. Poster PL14.4.
54. Moyle G, Sabin C, Cartledge J, et al. A 48-week, randomized, open-label comparative study of tenofovir DF vs abacavir as substitutes for a thymidine analog in persons with lipoatrophy and sustained virological suppression on HAART. Programa y resúmenes de la 12th Conference on Retroviruses and Opportunistic Infections; February 22-25, 2005; Boston, Massachusetts, USA. Abstract 44LB.
55. Palacios R, Santos J, Domingo P, et al. Impact of switching from stavudine (d4T) to tenofovir DF (TDF) on cardiovascular (CV) risk factors in patients with lipoatrophy (LIPO-REC Study). Programa y resúmenes de la 3rd Conference on HIV. Pathogenesis and Treatment; July 24-27, 2005; Rio de Janeiro, Brazil. Abstract TuPe".3C15.
56. Calza L, Manfredi R, Chiodo F. Comparison between switching therapy from protease inhibitors to a NNRTI and lipid-lowering therapy with pravastatin or bezafibrate for the management of HAART-related dyslipidemia. Programa y resúmenes de la 12th Conference on Retroviruses and Opportunistic Infections; February 22-25, 2005; Boston, Massachusetts, USA. Abstract 859.
57. Richter W, Rockstroh J. HIV and lipid elevations: risk factors, implications and management. In The Art of HIV Management Series. Global Biomedical Publishing and Communications. 2001, Illinois, USA:Abbott Laboratories; 2001:1-16.
 
 
 
 
 
 
 
 
 
 
 
 
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