Coronary artery disease and HIV; getting to the HAART of the matter

Management of cardiovascular conditions in a cohort of patients with HIV: experience from a joint HIV/cardiology clinic

“…10 This has led to an increased incidence of CAD, partly due to the adverse effects of ART. 11 The other factor is increasing life expectancy due to ART and consequent overexposure of this group to traditional risk factors of CAD.…”

Human Immunodeficiency Virus Infection–Related Heart Disease

“…1,2 Certain antiretroviral medications, especially PIs and NRTIs, have been linked to metabolic dysregulation (increased insulin resistance, dyslipidemia, and lipodystrophy) through a direct impact on lipid and glucose metabolism. 2,3,7 PIs lead to decreasing levels of high-density lipoproteins and to increasing levels of triglycerides. 2 The Data Collection in the Adverse Effects of Anti-HIV Drugs (D:A:D) study found an increased risk of CAD and ACS in patients taking PIs that was attributed to these dysmetabolic effects.…”

“…9 Although PIs are associated with dysmetabolic effects, their long-term benefits tend to outweigh their short-term risk factors. 2,3,7 Nonetheless, providers should be aware of this increased risk. Statins and fibrates are the first-line drugs in the management of dyslipidemia among HIV-infected patients.…”

“…Caution is advised, as there are still drugdrug interactions that may occur between statins and PIs because of their shared metabolism via the cytochrome P450 system, which may lead to statin toxicity. 7 Pravastatin has the least risk of drug-drug interactions with PIs, with the exception of ritonavir and darunvir. 7 Although new ART is not typically started in the ED, providers should be aware of possible drug-drug interactions with common coprescriptions such as statins.…”

“…7 Pravastatin has the least risk of drug-drug interactions with PIs, with the exception of ritonavir and darunvir. 7 Although new ART is not typically started in the ED, providers should be aware of possible drug-drug interactions with common coprescriptions such as statins.…”