Terapia hipolipemiante em situações especiais: síndrome de imunodeficiência adquirida

Abstract

Lipid alterations can be observed early among patients with AIDS disease. Commonly, these lipid abnormalities include low HDL-C and modest increase in triglyceride plasma levels. Highly Active Anti-Retroviral Therapy (HAART) in these patients may aggravate the dyslipidemia, with notable increases in triglycerides as well as in LDL-C. There are several mechanisms proposed to explain the mixed hyperlipidemia observed in these subjects, including different steps in lipid metabolism. The importance of the treatment of dyslipidemia became evident with the increased life expectancy and reports of cardiovascular complications in these individuals. There is an insulin resistance state in patients with AIDS disease under treatment with HAART, who present with lipodystrophy, hypertriglyceridemia, low levels of HDL-C. Antiretroviral drugs are metabolized by CYP P450 3A4 and interactions with some statins, especially with simvastatin are expected to occur. Treatment with lipid-lowering agents should be based on lipid profile and coronary risk. For hypertriglyceridemias, fibrates (mainly fenofibrate or bezafibrate) should be the drugs of choice, as well as statins (mainly pravastatin). Combined treatment using fibrates plus statins are recommended for severe mixed hyperlipidemias under very close monitoring for adverse effects.

Metabolic abnormalities and overweight in HIV/AIDS persons-treated with antiretroviral therapy

“…It has been observed, however, that the treatment benefits have been accompanied by a number of side effects, especially metabolic and nutritional abnormalities, which are associated with a higher risk of early atherosclerotic complications 5,6 . Scientific evidences show that the main risk factors for the development of metabolic abnormalities associated with the use of antiretroviral drugs are: treatment duration, more advanced stages of the disease, and especially the use of certain drug classes, such as protease inhibitors (IP) 7 .…”

Rosuvastatina e ciprofibrato no tratamento da dislipidemia em pacientes com HIV

“…Cardiovascular complications associated with HIV infection and related to the adverse effects of antiretroviral agents have become more frequent 6 . Despite the initial benefits of HAART, some studies have shown that treatment with those medications is associated with metabolic changes, such as lipodystrophy (body fat redistribution), insulin resistance, hyperglycemia, and dyslipidemia, with consequent elevation in the risk for atherosclerosis 7,8 .…”

Angina pectoris in patients with HIV/AIDS: prevalence and risk factors

“…In this connection, a reduction in the frequency of heart alterations caused by opportunistic agents has been reported as well as an increase in atherosclerotic coronary events in patients with HIV/AIDS. 5,6 The action of HIV itself, 7 exposure to traditional risk factors for coronary heart disease (CHD), 8 and the adverse effects of antiretroviral drugs in the cardiovascular system [9][10][11][12] have all been suggested as the determining factors in these atherosclerotic alterations.…”