Treatment of human immunodeficiency...

Treatment of human immunodeficiency virus (HIV) infection with certain antiretroviral agents is associated with increased offspring lipid levels. Successful suppression of HIV replication by dint of multiple drug regimens has greatly increased the life expectancy of infected patients, raising troubles that the dyslipidemic side meanings of therapy could affect long-term survival. Dube and colleagues review the evaluation of lipid disorders in patients with HIV infection and hint guidelines for management.

Hyperlipidemia was recognized as a side power of antiretroviral therapy when protease inhibitors (PIs) came into widespread use. In the Swiss HIV Cohort investigation 60 percent of patients taking PIs had cholesterol of the same heights greater than 240 mg by dL (6.20 mmol per L) and 75 percent had triglyceride evens greater than 500 mg by means of dL (5.65 mmol per L) The cholesterol flat most increased by PI use is very-low-density lipoproteins (VLDL) Increased low-density lipoprotein flushs have been reported in one but not all, studies. High-density lipoprotein horizontals do not appear to be substantially affected at antiretroviral therapy. Patients taking the PI ritonavir commonly have elevated triglyceride of the same heights The PIs associated with the fewest dyslipidemic results are indinavir and saquinavir.

Antiretroviral treatment with nucleoside reverse-transcriptase inhibitors (NRTIs) and non-nucleoside reverse-transcriptase inhibitors (NNRTIs) has been linked to more [i]or[/i] less dyslipidemic changes, but these changes are not as frequent or as severe as those associated with PIs. Switching dyslipidemic patients from a PI regimen to an NRTI or NNRTI regimen may be preferable to starting a lipid-lowering medication.However, many patients already will have had extensive experience with NRTI and NNRTI agents and go proceed the risk of viral reverberate if a less effective regimen is used.

The authors caution that interventions for effective viral suppression, opportunistic infections, malignancies, and HIV-associated wasting should take antecedence over treatment of hyperlipidemia. The general treatment approach is similar to that used for non-HIV-infected patients (see the accompanying figure). The guideline insinuates specific lipid-lowering agents and propounds details about drug interactions between lipid-lowering and antiretroviral agents.

BILL ZEPF MD

Dube MP et al. Guidelines for the evaluation and management of dyslipidemia in human immunodeficiency virus (HIV)-infected adults receiving antiretroviral therapy: recommendations of the HIV Medicine Association of the Infectious Disease Society of America and the Adult AIDS Clinical Trials arrange Clin Infect Dis September 1 2003; 37:613-27

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