Risk of premature atherosclerosis and ischemic heart disease associated with HIV infection and antiretroviral therapy

Calza, Leonardo; Manfredi, Roberto; Pocaterra, Daria; Chiodo, Francesco

doi:10.1016/j.jinf.2008.02.006

Cited by 63 publications

(63 citation statements)

References 136 publications

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“…The pathogenesis of glucose metabolism disorders is still unclear and, although a direct effect of potent antiretroviral combinations is certainly involved, it is likely that multiple factors play a role, including genetic predisposition, cytokine and hormonal alterations, changes in the immune system, non-antiretroviral drug-induced toxic effects, opportunistic diseases, and perhaps the HIV infection itself [167]. Risk factors for the development of IR in HIV-positive population include duration of ART, PI treatment, concurrent fat redistribution syndrome, dyslipidemia, increasing age, hepatitis C virus co-infection, as well as pharmacological treatment with pentamidine or megestrol acetate [100,[167][168][169].…”

Section: Insulin Resistancementioning

confidence: 99%

“…In patients receiving cART, the prevalence of hyperlipidemia ranges from 28 to 80% in different studies [167,174], and it includes hypertriglyceridemia in the majority of cases [123]. Dyslipidemia is frequently, but not always, associated with fat redistribution syndrome: although lipid and glucose metabolism alterations are more common in patients with body-fat abnormalities, they are also observed in those without these morphological changes [167].…”

Section: Dyslipidemiamentioning

confidence: 99%

“…Dyslipidemia is frequently, but not always, associated with fat redistribution syndrome: although lipid and glucose metabolism alterations are more common in patients with body-fat abnormalities, they are also observed in those without these morphological changes [167].…”

Section: Dyslipidemiamentioning

confidence: 99%

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Lipodystrophy: The Metabolic Link of HIV Infection with Insulin-Resistance Syndrome

Freitas¹,

Carvalho²,

Souto³

et al. 2013

Current Perspectives in HIV Infection

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Section: Insulin Resistancementioning

confidence: 99%

Section: Dyslipidemiamentioning

confidence: 99%

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Lipodystrophy: The Metabolic Link of HIV Infection with Insulin-Resistance Syndrome

Freitas¹,

Carvalho²,

Souto³

et al. 2013

Current Perspectives in HIV Infection

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“…21,22 This, while HAART helps to reduce endothelial injury by controlling HIV infection, it also activates the endothelium by interfering in glucose and lipid metabolism. 23 Assessing the relationship between HAART and cardiovascular risk is complicated, since the currently recommended combined therapy regimes include drugs of various classes, making it difficult to draw reliable conclusions. In addition, many patients are medicated with different regimes over time, due to therapeutic failure or adverse effects.…”

Section: Hiv and The Pathophysiology Of Cardiovascular Diseasementioning

confidence: 99%

HIV and coronary disease – When secondary prevention is insufficient

Carvalho

Valente

Morais

et al. 2017

Revista Portuguesa de Cardiologia (English Edition)

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Highly active antiretroviral therapy (HAART) has created a new paradigm for human immunodeficiency virus (HIV)-infected patients, but their increased risk for coronary disease is well documented.We present the case of a 57-year-old man, co-infected with HIV-2 and hepatitis B virus, adequately controlled and with insulin-treated type 2 diabetes and dyslipidemia, who was admitted with non-ST elevation acute myocardial infarction. Coronary angiography performed on day four of hospital stay documented two-vessel disease (mid segment of the right coronary artery [RCA, 90% stenosis] and the first marginal). Tw o drug-eluting stents were successfully implanted. The patient was discharged under dual antiplatelet therapy (aspirin 100 mg/day and clopidogrel 75 mg/day) and standard coronary artery disease medication. He was admitted to the emergency room four hours after discharge with chest pain radiating to the left arm and inferior ST-segment elevation myocardial infarction was diagnosed. Coronary angiography was performed within one hour and documented thrombosis of both stents. Optical coherence tomography revealed good apposition of the stent in the RCA, with intrastent thrombus. Angioplasty was performed, with a good outcome.The acute stent thrombosis might be explained by the thrombotic potential of HIV infection and diabetes. There are no specific guidelines regarding HAART in secondary prevention of acute coronary syndromes. A multidisciplinary approach is essential for optimal management of these patients. © 2017 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. All rights reserved. Document downloaded from http://www.elsevier.es, day 24/08/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from http://www.elsevier.es, day 24/08/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. 569.e2A.S. Carvalho et al. PALAVRAS-CHAVEVírus da imunodeficiência humana; Trombose de stent; Doença coronária VIH e doença coronária ---quando a prevenção secundária é insuficienteResumo A terapêutica antiretroviral (TARV) alterou o paradigma da infeção pelo vírus da imunodeficiência humana (VIH), conhecendo-se o risco aumentado de doença coronária nestes doentes.Apresenta-se o caso de um homem de 57 anos, melanodérmico, com coinfecção VIH-2/vírus hepatite B, com controlo adequado; diabetes mellitus tipo 2, insulino-tratado e dislipidemia. Internado por enfarte agudo do miocárdio, sem supradesnivelamento ST. Realizou cateterismo ao 4.• dia de internamento, documentando-se doença de dois vasos (segmento médio da coronária direita [CD] [90% estenose] e 1. a obtusa marginal [OM1] com estenose de 95%). Colocaram-se dois stents revestidos, sem intercorrências. Teve alta sob dupla antiagregação (ácido acetilsalicílico 100 mg/dia e clopidogrel 75 mg/dia) e restante terapêutica dirigida à doença coronária. Recorreu ao serviço de urgência quatro horas após a alt...

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“…A recent treatment interruption trial in Thai HIVinfected patients demonstrated an association between markers of CVD, including increased vascular cell adhesion molecule-1, decreased adiponectin, and increased HIV RNA replication (175) , which further supports this finding. Currently, risk-prediction models such as the Framingham score are recommended for use in estimating CVD risk (162) . The Framingham equations, developed over a decade ago for use in non-HIV-infected individuals (176) , have been used to estimate CVD risk in HIV-infected subjects (73,172,175) ; however, studies assessing the accuracy of this model in HIV-infected patients are limited (177) .…”

Section: Cvdmentioning

confidence: 99%

Nutrition and the HIV-associated lipodystrophy syndrome

Loonam

Mullen

2012

Nutr. Res. Rev.

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HIV-associated lipodystrophy syndrome (HALS), comprising metabolic and morphological alterations, is a known side effect of highly active antiretroviral therapy (HAART). Evidence for the role of nutrition in the management of the systemic parameters of HALS is currently limited. In the present paper we review the current knowledge base surrounding HALS, focusing particularly on the role of nutrition in mitigating the systemic parameters of the syndrome. Reported prevalence of HALS was found to vary from 9 to 83 % due to lack of a standardised definition, as well as variations in assessment methods and in the study population used. HALS is associated with both morphological (lipoatrophy, lipohypertrophy) and metabolic (dyslipidaemia, glucose intolerance, diabetes, hypertension, endothelial dysfunction and atherosclerosis) alterations, which may occur singly or in combination, and are associated with an increased risk of CVD. HAART-induced adipocyte inflammation, oxidative stress and macrophage infiltration, as well as altered adipocyte function and mitochondrial toxicity, have been shown to be central to the development of HALS. The adipocyte, therefore, represents a plausible target for treatment. Pharmacological and surgical treatment interventions have shown effect. However, their use is associated with numerous adverse effects and complications. Targeted lifestyle interventions may provide a useful alternative for managing HALS owing to their safety and tolerability. A Mediterranean-style diet has been found to be effective in improving the systemic parameters of HALS. Furthermore, the effects of n-3 PUFA supplementation are encouraging and future randomised controlled trials investigating the beneficial effects of n-3 PUFA in HALS are justified.

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Risk of premature atherosclerosis and ischemic heart disease associated with HIV infection and antiretroviral therapy

Cited by 63 publications

References 136 publications

Lipodystrophy: The Metabolic Link of HIV Infection with Insulin-Resistance Syndrome

Lipodystrophy: The Metabolic Link of HIV Infection with Insulin-Resistance Syndrome

HIV and coronary disease – When secondary prevention is insufficient

Nutrition and the HIV-associated lipodystrophy syndrome

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