Metabolic and cardiovascular effects of combined antiretroviral therapy in patients with HIV infection. Systematic review of literature

Laura Casaretti, Stefania Paolillo, Roberto Formisano, Ada Bologna, Giacomo Mattiello, Sirio Conte, Laura Petraglia, Francesco Lo Iudice, Irma Fabiani, Anna Paola Cirillo, Alice Vitagliano, Francesco Gambardella, Giuseppe Luca della Ratta, Pasquale Perrone Filardi
  • Laura Casaretti
    Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Università Federico II, Napoli, Italy
  • Stefania Paolillo
    Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Università Federico II, Napoli, Italy
  • Roberto Formisano
    Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Università Federico II, Napoli, Italy
  • Ada Bologna
    Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Università Federico II, Napoli, Italy
  • Giacomo Mattiello
    Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Università Federico II, Napoli, Italy
  • Sirio Conte
    Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Università Federico II, Napoli, Italy
  • Laura Petraglia
    Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Università Federico II, Napoli, Italy
  • Francesco Lo Iudice
    Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Università Federico II, Napoli, Italy
  • Irma Fabiani
    Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Università Federico II, Napoli, Italy
  • Anna Paola Cirillo
    Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Università Federico II, Napoli, Italy
  • Alice Vitagliano
    Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Università Federico II, Napoli, Italy
  • Francesco Gambardella
    Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Università Federico II, Napoli, Italy
  • Giuseppe Luca della Ratta
    Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Università Federico II, Napoli, Italy
  • Pasquale Perrone Filardi
    Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Università Federico II, Napoli, Italy | fpperron@unina.it

Abstract

In HIV infected patients an increased incidence of cardiac events has been reported since the introduction of highly active antiretroviral therapy (HAART). Antiretroviral drugs’ regimens are, in fact, associated with several metabolic side effects, such as dyslipidemia, impaired glucose metabolism and abnormal body fat distribution, that increase cardiovascular risk of HIV subjects. In addition, HIV infection itself, the chronic inflammatory status and the frequent presence in this population of traditional risk factors contribute to an higher incidence of cardio and cerebrovascular events. In last years several studies showed the occurrence of carotid vascular impairment in patients treated with protease inhibitors (PI). Similarly the DAD Study reported an increase of 26% of the risk of myocardial infarction in patients on HAART and that this risk was independently associated with longer exposure to PI, after multivariate adjustments. A correct evaluation of the metabolic status before starting HAART and an adequate control of drugs-related metabolic abnormalities may reduce the incidence of cardiac events and still improve HIV patients prognosis. This review will focus on the metabolic effects of antiretroviral drugs and on the contribution of combination antiretroviral therapy on cardiovascular risk.

Keywords

HIV, antiretroviral drugs, cardiovascular risk, metabolic syndrome, myocardial infarction.

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Submitted: 2015-12-04 15:43:56
Published: 2015-12-04 16:50:55
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Copyright (c) 2015 Laura Casaretti, Stefania Paolillo, Roberto Formisano, Ada Bologna, Giacomo Mattiello, Sirio Conte, Laura Petraglia, Francesco Lo Iudice, Irma Fabiani, Anna Paola Cirillo, Alice Vitagliano, Francesco Gambardella, Giuseppe Luca della Ratta, Pasquale Perrone Filardi

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