JAC Advance Access published online on November 25, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh013
© 2003 by The British Society for Antimicrobial Chemotherapy
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Leading article
1 Department of Clinical and Experimental Medicine, Division
of Infectious Diseases, University of Bologna ‘Alma Mater
Studiorum’, S. Orsola Hospital, Via Massarenti 11, I-40138
Bologna, Italy
* Corresponding author. E-mail: calza{at}med.unibo.it.
Highly active antiretroviral therapy (HAART) has had
a significant impact on the natural history of human immunodeficiency
virus (HIV) infection, leading to a remarkable decrease in its morbidity
and mortality, but is frequently associated with clinical and metabolic
complications. Fat redistribution or lipodystrophy, hypertriglyceridaemia,
hypercholesterolaemia, insulin resistance and diabetes mellitus
have been extensively reported in subjects treated with protease
inhibitor (PI)-based antiretroviral regimens. In particular, dyslipidaemia
occurs in up to 70-80% of HIV-infected individuals
receiving HAART and can be associated with all the available PIs,
although hypertriglyceridaemia appears to be more frequent in patients
treated with ritonavir, ritonavir-saquinavir, or ritonavir-lopinavir.
The potential long-term consequences of HAART-associated hyperlipidaemia
are not completely understood, but an increased risk of premature coronary
artery disease has been reported in young HIV-positive persons receiving
PIs. Dietary changes, regular aerobic exercise and switching to
a PI-sparing regimen may act favourably on dyslipidaemia. Lipid-lowering
therapy is often required with statins or fibrates. The choice of
hypolipidaemic drugs should take into account potential pharmacological
interactions with antiretroviral agents.
Keywords: HIV infection, antiretroviral therapy, hyperlipidaemia,
fibrates, statins
Dyslipidaemia associated with antiretroviral therapy
in HIV-infected patients
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