HIV Digest	HIV Digest Archive

As HIV infection becomes a chronic, manageable disease and members of the HIV-infected population age, we are likely to see an emergence of many chronically prevalent diseases, including diabetes mellitus and cardiovascular disease (CVD). CVD risk data from the largest and longest studied cohorts in the setting of HIV infection suggest that cumulative years of exposure to combination drug therapy increases the risk of myocardial infarction and stroke. Clinicians need to implement preventative and pre-emptive measures within the HIV population to slow the emergence of a potential CVD epidemic. As such, health care professionals need to consider CVD risk assessment as a routine component of the medical care of individuals with HIV infection.

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here are several tactics appropriate to managing this long-term risk. The first includes the routine institution and consistent encouragement of therapeutic lifestyle changes, including smoking cessation, weight reduction, regular exercise and adherence to a Mediterranean diet rich in fresh fruits and vegetables and omega-3 fatty acids.

Another tactic involves considering the impact of specific anti-retroviral agents on lipid levels and insulin resistance, which may be most appropriate at the time of treatment initiation. Differences have emerged between the NRTI, NNRTI and PI classes and between different combinations of these agents within treatment regimens. Thus, the effects of these drugs on lipids may be regimen specific rather than drug specific alone. Some newer agents such as atazanavir and tenofovir appear to have best-in-class lipid profiles, and the use of NNRTIs generally causes little change in the ratio of total cholesterol to HDL cholesterol.

Intervention with conventional lipid-lowering therapy is recommended for individuals who do not achieve appropriate targets through treatment switching or for whom this option is not appropriate. The addition of lipid-lowering agents, including statins, ezetimibe and fibrates, to ART leads to changes in lipids similar, though to a lesser degree, than those observed in the general population.

The effect of newer lipid-lowering agents, such as ezetimibe and rosuvastatin (Crestor), on the pharmacokinetics of anti-retrovirals requires further investigation before these drugs can be widely recommended.

from TheBodyPro.com