Ischemic Heart Disease in HIV: An In-depth Look at Cardiovascular Risk

Raposeiras‐Roubín, Sergio; Triant, Virginia A.

doi:10.1016/j.rec.2016.10.005

Cited by 10 publications

(9 citation statements)

References 40 publications

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“…However, these regimens are associated with heightened platelet activation 30. In addition, there is continued argument as to whether abacavir increases CVD risk; some treatment guidelines still suggest caution in its use in individuals with high Framingham CVD risk scores 1 12 15 34. Part of the controversy involving atazanavir concerns the role of residual confounders in analysis of a relatively small cohort 33.…”

Section: Introductionmentioning

confidence: 99%

HIV-associated cardiovascular disease: importance of platelet activation and cardiac fibrosis in the setting of specific antiretroviral therapies

2018

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HIV infection is a risk factor for cardiovascular disease (CVD). This risk is accentuated by certain combination antiretroviral therapies (cARTs), independent of their effects on lipid metabolism and insulin sensitivity. We sought to define potential mechanisms for this association through systematic review of clinical and preclinical studies of CVD in the setting of HIV/cART from the English language literature from 1989 to March 2018. We used PubMed, Web of Knowledge and Google Scholar, and conference abstracts for the years 2015–March 2018. We uncovered three themes: (1) a critical role for the HIV protease inhibitor (PI) ritonavir and certain other PI-based regimens. (2) The importance of platelet activation. Virtually all PIs, and one nucleoside reverse transcriptase inhibitor, abacavir, activate platelets, but a role for this phenomenon in clinical CVD risk may require additional postactivation processes, including: release of platelet transforming growth factor-β1; induction of oxidative stress with production of reactive oxygen species from vascular cells; suppression of extracellular matrix autophagy; and/or sustained proinflammatory signalling, leading to cardiac fibrosis and dysfunction. Cardiac fibrosis may underlie an apparent shift in the character of HIV-linked CVD over the past decade from primarily left ventricular systolic to diastolic dysfunction, possibly driven by cART. (3) Recognition of the need for novel interventions. Switching from cART regimens based on PIs to contemporary antiretroviral agents such as the integrase strand transfer inhibitors, which have not been linked to clinical CVD, may not mitigate CVD risk assumed under prior cART. In conclusion, attention to the effects of specific antiretroviral drugs on platelet activation and related profibrotic signalling pathways should help: guide selection of appropriate anti-HIV therapy; assist in evaluation of CVD risk related to novel antiretrovirals; and direct appropriate interventions.

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Section: Introductionmentioning

confidence: 99%

HIV-associated cardiovascular disease: importance of platelet activation and cardiac fibrosis in the setting of specific antiretroviral therapies

2018

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“…Also, the measured glycemic values after one year indicated the existence of statistical significance, which is in favor of other studies that indicate the relationship between antiretroviral therapy and insulin resistance (8). Previous studies showed that the incidence of type 2 diabetes mellitus is four times more common in HIV positive patients compared to the general population, and abacavir affects insulin resistance, in particular (9).…”

Section: Discussionmentioning

confidence: 67%

Risk assessment for the development of metabolic syndrome in patients with AIDS, after the first year of antiretroviral therapy

Pejković¹,

Stojic²,

Jovicić³

2019

Medicinski podmladak

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Introduction: Antiretroviral therapy (ART) in the treatment of HIV infection has allowed maximum control of viral replication and reconstruction of the immune system, which has contributed to the long-term survival. However, it has been observed that a long-term use of ART can lead to cumulative toxicity and metabolic abnormalities. Aim: The aim of this study was to determine whether there is a difference in lipidogram, glycemia and body mass index (BMI) before and after the initiation of ART, and to determine in which of the antiretroviral drugs the changes in the values of the measured variables were most common. Material and methods: The research was conducted at the Clinic for Infectious Diseases, Clinical Center of Kragujevac, as a prospective study involving 40 patients diagnosed with HIV infection. Biochemical parameters and BMI calculation were performed before the initiation of ART and one year after. Results: The analysis of the observed variables indicated a statistically significant difference in total cholesterol (p = 0.001), HDL (p = 0.002), LDL (p = 0.003), triglycerides (p < 0.001), glucose (p < 0.001) and BMI (p = 0.002). By analyzing the administered АRT therapy, statistical significance was achieved in the measured triglyceride values after the administration of ritonavir and lopinavir, while the highest BMI values, compared to initial ones, were observed after the administration of ritonavir, but without achieving statistical significance. Conclusion:The results of the study showed that АRТ therapy has effect on the development of hyperlipidemia, which may be associated with an increased risk of developing cardiovascular disease and protease inhibitors of the older generation are highlighted, in particular. АRT therapy in HIV-infected cells contributes to the development of a metabolic syndrome involving dyslipidemia, lipodystrophy and insulin resistance.Uvod: Antiretrovirusna terapija u lečenju infekcije virusa humane imunodeficijencije (HIV) omogućila je maksimalnu kontrolu virusne replikacije i rekonstrukciju imunog sistema, što je doprinelo dužem preživljavanju, čak i kod bolesnika sa uznapredovalom bolešću. Uočeno je, ipak, da dugotrajna primena antiretrovirusne terapije može dovesti do kumulativne toksičnosti i razvoja metaboličkih abnormalnosti. Cilj: Cilj istraživanja je bio da utvrdimo da li postoji razlika u izmerenim vrednostima lipidograma, glikemije i indeksa telesne mase pre i nakon započinjanja antiretrovirusne terapije, kao i da utvrdimo kod kojih se antiretrovirusnih lekova najčešće javljaju promene u vrednostima izmerenih varijabli. Materijal i metode: Istraživanje je sprovedeno u Kliničkom centru Kragujevac, Klinika za infektivne bolesti, u vidu prospektivne studije u kojoj je učestvovalo 40 bolesnika, kod kojih je dijagnostikovana HIV infekcija. Biohemijski parametri i izračunavanje indeksa telesne mase vršeni su pre i godinu dana nakon započetog lečenja antiretrovirusnom terapijom. Podaci su statistički obrađeni u statističkom programu SPSS (verzija 22.0). Rezultati: Anali...

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“…Острый коронарный синдром (ОКС) -одна из частых причин госпитализации пациентов с ВИЧ. У ВИЧ-инфицированных пациентов ИМ возникает в 2 раза чаще и на 10 лет раньше по сравнению с лицами без ВИЧ [20,21], хотя это подтверждается не всеми исследователями [22].…”

Section: острый коронарный синдром на фоне вич-инфекцииunclassified

Coronary Heart Disease in HIV-Infected Patients

Аржакова

Shekhovtsova

Duplyakov

2020

Racionalʹnaâ farmakoterapiâ v kardiologii

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Currently, there are methods of drug exposure to the infection caused by the human immunodeficiency viruses (HIV), that allow to suppress the active replication of the virus in the patient's body. The era of antiretroviral therapy, which has allowed HIV-infected people to live longer, has begun. This led to an increase in their cardiovascular diseases, which occur at an earlier age and are more severe than in people without HIV. Specific or “nontraditional” risk factors damaging vascular wall occur in HIV patients along with traditional risk factors. These factors include: the negative impact of HIV on endothelium, an imbalance of inflammatory mediators, pathological immune activation, a decrease in the level of CD4 cells, a change in the number and function of platelets. The question of the effect of antiretroviral therapy on the occurrence of atherosclerotic vascular lesions remains debatable. Acute coronary syndrome (ACS) is one of the most frequent and most severe cardiovascular events in HIV-infected patients. The risk of myocardial infarction is highest in patients with a viral load of HIV-1 ribonucleic acid (RNA)≥500 copies/ml and a CD4 cell count of <200/ml. The most common form of ACS in HIV patients is ACS with ST segment elevation. Treatment of ACS in HIV patients has some difficulties: a high frequency of stent thrombosis, the frequent occurrence of thrombocytopenia, drug interactions with antiretroviral therapy. The high risk of developing cardiovascular diseases in HIV patients necessitates the introduction of active measures of primary and secondary prevention, taking into account the specific interaction of all drugs taken by the patient.

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Ischemic Heart Disease in HIV: An In-depth Look at Cardiovascular Risk

Cited by 10 publications

References 40 publications

HIV-associated cardiovascular disease: importance of platelet activation and cardiac fibrosis in the setting of specific antiretroviral therapies

HIV-associated cardiovascular disease: importance of platelet activation and cardiac fibrosis in the setting of specific antiretroviral therapies

Risk assessment for the development of metabolic syndrome in patients with AIDS, after the first year of antiretroviral therapy

Coronary Heart Disease in HIV-Infected Patients

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