Management of lipid disorders in patients living with HIV

Abstract

Since the discovery and development of antiretroviral therapy (ART), HIV has become a chronic disease with patients living longer lives and to ages where co-morbidities, such as cardiovascular disease (CVD) are prevalent. Diagnosis and management of risk factors for CVD, in particular dyslipidemia, have become an important part of the overall care for patients living with HIV infection. Existing guidelines and recommendations for the management of dyslipidemia for persons with HIV infection are largely based on guidelines for the general population. Clinical and epidemiologic research efforts are ongoing to provide information specific to patients living with HIV. This review offers a detailed guide for clinicians who manage dyslipidemia in patients infected with HIV. The first sections provide background information on dyslipidemia, risk stratification, and targets for lipid therapy. This is followed by a step-by-step approach for diagnosis and treatment with specific information on lipid drug use for patients with HIV. The recommendations presented here are based on existing guidelines for the general population, evidence from research in patients infected with HIV, and the clinical experience of the authors. Management issues for which little or no information is available specific to this patient population are noted and serve to highlight the many gaps in our knowledge that will need to be addressed.

A PRISMA-compliant systematic review and meta-analysis of randomized controlled trials investigating the effects of statin therapy on plasma lipid concentrations in HIV-infected patients

“…Since pravastatin is a cytochrome P450 independent and water- The mechanism underlying the interactions between pravastatin and anti-retroviral drugs may be due to a competition at the cytochrome level that transports protein P-glycoprotein and may also be caused by genetic polymorphism (13). However, in HIV-infected patients on statin therapy, it has been recommended that plasma concentrations of protease inhibitors be evaluated to avoid drug-drug interaction (38). Current guidelines suggest that in HIV patients receiving protease inhibitors, fluvastatin and pravastatin are most safe to use, atorvastatin can be used at submaximal efficacy doses and administrated only with caution and monitoring, while lovastatin and simvastatin should not be used (35).…”

Lipid-Lowering Therapy in HIV-Infected Patients: Relationship with Antiretroviral Agents and Impact of Substance-Related Disorders

“…Although the CURVE study demonstrated atorvastatin 10, 20 and 40 mg produced greater reduction in low-density lipoprotein (LDL) cholesterol at equivalent doses of simvastatin, pravastatin, lovastatin and fluvastatin; cautions should be exercised with atorvastatin and most PI co-administration, except tipranavir, which is contraindicated with atorvastatin use. For co-administration, atorvastatin should be started with a low dose and gradually titrated to higher doses (10). Despite of a favorable drug interaction profile, pravastatin only accounted for 19% prescription likely due to its low efficacy.…”

“…Fluvastatin, pitavastatin and pravastatin (except for pravastatin with darunavir/r) have the least potential for drug-drug interactions, according to the guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents (10). Simvastatin and lovastatin are contraindicated with PIs due to an increased risk of myopathy and rhabdomyolysis as a result of drug interactions (10). Fibrates, such as gemfibrozil and fenofibrate, are also commonly used in hypercholesterolemia, hypertriglyceridemia and mixed dyslipidemia.…”

Mutations du gène d’apoprotéine B100 au cours des dyslipidémies chez les sujets vivant avec le VIH

“…L'évolution naturelle de l'infection à VIH est caractérisée par la réduction des concentrations de cholestérol hight density lipoprotein (C-HDL) et low density lipoprotein (C-LDL) et une augmentation des triglycérides (TG) (Lo, 2011;Myerson, 2015). Cependant, l'évolution de la cholestérolémie totale est variable (Elaine, 2013;Myerson, 2015;.…”

“…Cependant, l'évolution de la cholestérolémie totale est variable (Elaine, 2013;Myerson, 2015;. Après la mise sous traitements antirétroviraux (ARV), l'on observe dans le profil lipidique, des modifications plus graves, notamment l'augmentation des TG et du C-LDL et une diminution du C-HDL (Aberg et al, 2009 ;Tadewos et al, 2012;Dave et al, 2016 ;Adébayo et al, 2016) ; tous des facteurs de risque cardiovasculaires.…”