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- Variable frequency
- Associated with
PIs and other drugs (efavirenz)1-3
- Role of advancing
age needs to be clarified
- No increase in
cardiovascular mortality has been demonstrated 4-6
- Exists independently
of other aspects of lipodystrophy
•
Metabolic disturbances have always been a classic host response
to infection, including HIV.1 Decreases in high-density lipoprotein
(HDL) cholesterol are noted early in the course of HIV infection,
followed by decreases in low-density lipoprotein cholesterol. Changes
in triglycerides also take place during the transition to AIDS.
• More and more patients, however, particularly those receiving
protease inhibitors, are experiencing various dyslipidemias that
are not associated with the normal progression of HIV disease.2
As with the other metabolic and morphologic complications, the dyslipidemias
are characterized by a variable frequency. They are most often associated
with protease inhibitors in cohort studies. Other drugs, such as
efavirenz, have also been implicated.3 The advancing age of patients
with HIV infection may also play a role.
• At present, short-term follow-up studies suggest that there
is no increase in cardiovascular mortality in patients who develop
these conditions.4-6 Long-term studies are needed in order to eliminate
this concern entirely.
• Patients may also experience dyslipidemias independent of
other changes in body composition.
References:
1. Safrin S, Grunfeld C. Fat distribution and metabolic changes
in patients with HIV infection. AIDS. 1999;13:2493-2505.
2. Wanke CA. Epidemiological and clinical aspects of the metabolic
complications of HIV infection: the fat redistribution syndrome.
AIDS. 1999;13;1287-93.
3. Mulligan K, Grunfeld C, Tai VW et al. Hyperlipidemia and insulin
resistance are induced by protease inhibitors independent of changes
in body composition in patients with HIV infection. J Acquir
Immune Defic Syndr. 2000;23:35-43.
4. Klein D, Hurley L, Sidney S. Do protease inhibitors increase
the risk for coronary heart disease among HIV-positive patients?
7th Conference on Retroviruses and Opportunistic Infections, San
Francisco, CA; Jan 30 - Feb 2, 2000. Abstract 33.
5. Coplan P, Cormier K, Japour A et al. Myocardial infarction incidence
in clinical trials of 4 protease inhibitors. 7th Conference on Retroviruses
and Opportunistic Infections, San Francisco, CA; Jan 30 - Feb 2,
2000. Abstract 34.
6. Currier JS, Johnson DL, Dube M, Hodis H. A pilot study of carotid
intima media thickness (IMT) in HIV-infected women treated with
protease inhibitors. 7th Conference on Retroviruses and Opportunistic
Infections, San Francisco, CA, 2000. Abstract 32.
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