Dyslipidemia in HIV-infected individuals

Abstract

Metabolic complications continue to play a major role in the management of HIV infection. Dyslipidemia associated with HIV infection and with the use of combined antiretroviral therapy includes elevations in triglycerides, reduced high-density cholesterol, and variable increases in low-density and total cholesterol. The association between dyslipidemia and specifi c antiretroviral agents has been underscored. Multiple pathogenic mechanisms by which HIV and antiretroviral agents lead to dyslipidemia have been hypothesized, but they are still controversial. The potential clinical and pathological consequences of HIV-associated hyperlipidemia are not completely known, but several studies reported an increased risk of coronary artery disease in HIV-positive individuals receiving combined antiretroviral therapy. HIV-infected persons who have hyperlipidemia should be managed similarly to those without HIV infection in accordance with the National Cholesterol Education Program. Life style changes are the primary target. Statins and fi brates and/or modifi cation in antiretroviral therapy are possible approaches to this problem.

Perfil Metabólico De Portadores Do Hiv - Hospital De Clínicas De Curitiba

“…2/15 (13,33) 0/15 ( -) 0,2500 (5) TRIGLICERÍDEOS (n) 16 0,8065 (3) Média ± DP (2) Média ± DP (1) 6,80 ± 3,86…”

“…Além disso, como a TARV fez da infecção pelo HIV uma condição crônica, é importante considerar as comorbidades relacionadas ao avanço da idade que contribuem para o aumento do risco cardiovascular de portadores do vírus 10 . Com relação às mudanças do perfil metabólico, a infecção pelo HIV causa um desequilíbrio no metabolismo dos lipídios, caracterizado por baixos níveis de HDL-c, LDL-c e CT, e altos níveis de TG 1,5,6,11,12 . Após a introdução do IP, os níveis de HDL-c permanecem baixos e há aumento no CT, LDL-c e TG; enquanto que os regimes contendo ITRNN promovem aumento nas taxas de CT e LDL-c, e ainda, aumento concomitante dos níveis de HDL-c 13 .…”

“…Ainda assim, a contribuição relativa à TARV e aos efeitos da própria doença na gênese dessas alterações não está bem definida na literatura. 4 As alterações no perfil lipídico geralmente ocorrem entre o terceiro e o sexto mês do início da TARV, mas em regimes contendo IP podem ocorrer mais precoce e pronunciadamente 5 . A duração da exposição à TARV também tem sido associada ao desenvolvimento de alterações metabólicas.…”

Dyslipidemia in Patients with Lipodystrophy in the Use of Antiretroviral Therapy

“…This does not mean that the occurrence of dyslipidemia has emerged only with the implementation of antiretroviral drugs to treat AIDS. Before the existence of HAART had been reported lipid profile changes with high levels of triglycerides and low rate of VLDL-C and HDL-C (Sprinz et al, 2010;Grunfeld et al, 1992). Several studies investigate ways of relating to HAART the effects of dyslipidemia like type of drug used by the patient and how the treatment regimen it has been implemented, but is still lacking a precise explanation for the lipid profile origin.…”

“…Protease inhibitors (PI) are associated with dyslipidemia and insulin resistance for a considerable time, specifically ritonavir, and a variety of hypotheses (albeit not conclusive) it is presented to explain this association (Noor, 2007;Dubé et al, 2003). One proposed mechanism to emergence of dyslipidemia is the lipoprotein lipase inhibition by PI, responsible for LDL-C increased, due to difficulty in capturing chylomicrons, resulting in lower hepatic clearance of triglycerides (Sprinz et al, 2010, as cited in Carr & Mooser, 2001). Another hypothesis is that PI has the ability to inhibit steps in lipid metabolism by binding to cellular retinoic acid binding protein type 1 (CRABP-1) and www.intechopen.com related protein receptor LDR-c, resulting in hyperlipidemia by higher release of lipids in the circulation.…”