Management of Cardiovascular and Metabolic Alterations in HIV positive patients

The number of people that live with HIV continue to increase due to ample access to antiretroviral therapy (ART) that enables a higher life expectancy for the patients. The lipid changes in HIV infected patients include decrease in the high density lipoprotein (HDL) and a reduction of the serum concentration of LDL, which is associated with an increase in levels of triglycerides and very low density lipoprotein (VLDL). ART promoted great advancements in the reduction of the morbidity and mortality of individuals with HIV/AIDS. This fact contributed to a significant increase in life expectancy and quality of life of these people compared to before the development of ART. ART inherent benefits are undeniable and have been demonstrated already in various studies. However, besides the benefits, the adverse effects of these drugs are increasingly notable in each antiretroviral drug class. Metabolic disorders with lipid and glucose profile alterations were found in most antiretroviral drug classes, especially in the protease inhibitors (PIs). Such alterations result in an increased prevalence of cardiovascular diseases (CVD), therefore should be analyzed with criteria in all individuals that receive antiretroviral treatment. Cardiovascular risk stratification scores are heavily used and despite being useful they present limited capability, especially because they do not consider the HIV infection. The treatment of the lipid profile modifications must be primarily based in life style changes, diet and physical exercise and when persistent, pharmacotherapy, notably the statins, should be utilized.