Coronary heart disease in HIV-infected patients in the highly active antiretroviral treatment era

Protease inhibitor exposure and increased risk of cardiovascular disease in HIV‐infected patients

“…Reports from large observational studies demonstrate that considerable controversy exists over the association of HAART, particularly protease inhibitor (PI) therapies, with increased cardiovascular disease (CVD) risk [12][13][14][15][16][17]. PIs have been associated with alterations in surrogate markers of CVD, including coronary calcium scores and endothelial function [18,19], as well as with metabolic complications such as hyperlipidaemia, fat redistribution, insulin resistance, hypertension and diabetes mellitus [19][20][21][22][23][24].…”

“…In some reports, death from nonAIDS-related causes exceed those attributed to AIDS in this patient population [2,[7][8][9], and cardiovascular deaths are increasing in these patients [1,2]. Recent reports suggest a shift in the relative cause of death among HIV-infected individuals, with cardiovascular deaths accounting for fewer than 4% of all deaths pre-1997 [1,10], and for 7-10% in more recent years [8,10,11].Reports from large observational studies demonstrate that considerable controversy exists over the association of HAART, particularly protease inhibitor (PI) therapies, with increased cardiovascular disease (CVD) risk [12][13][14][15][16][17]. PIs have been associated with alterations in surrogate markers of CVD, including coronary calcium scores and endothelial function [18,19], as well as with metabolic complications such as hyperlipidaemia, fat redistribution, insulin resistance, hypertension and diabetes mellitus [19][20][21][22][23][24].…”

Endothelial Dysfunction in HIV

“…Supporting these findings were autopsy reports which demonstrated that HIV-1 infected patients without traditional cardiac risk factors also had unexpectedly higher rates of atherosclerosis, with endothelial lymphocytic infiltration, compared with controls (Joshi et al, 1987). The current incidence of coronary artery disease in the HIV-1 infected population is at least three-fold higher than the general population (Vittecoq et al, 2003) even in the absence of traditional risk factors, suggesting that HIV-1 is an independent risk factor for vascular disease.…”

“…In recent years, reports have shown that HIV-infected patients have a greater risk of developing coronary artery disease compared to HIV-uninfected patients of the same age (Vittecoq et al, 2003). In the absence of anti-retrovirals, chronic inflammation, hypercoagulability, cell adhesion and platelet activation appear to drive the pathogenesis behind endothelial dysfunction in HIV-infected individuals (Francisci et al, 2009).…”

Benefícios do treinamento aeróbio e/ou resistido em indivíduos HIV+: uma revisão sistemática

“…O tratamento farmacológico é comumente denominado: terapia antirretroviral (TARV), terapia antirretroviral potente (TARP) ou Highly active antiretroviral therapy (HAART) e o esquema terapêutico mais adotado é composto por três classes de medicamentos antirretrovirais: ITRN (ITRNt) ou inibidores da transcriptase reversa aná-logos de nucleosídeos; ITRNN ou inibidores da transcriptase reversa não análogos de nucleosídeos e/ou inibidor da protease ou IP (1,(3)(4)(5) . Diante do quadro clínico criado pela própria infecção e/ou pelos efeitos adversos impostos pelos medicamentos antirretrovirais, tais como: imunossupressão, incapacidade funcional de trabalho, dislipidemias, hipotrofia muscular, lipodistrofia ou síndrome lipodistrófica, doenças arterocoronarianas, diabetes mellitus tipo 2, acidose láctica, depressão, o exercício físico como terapia coadjuvante ganhou muita atenção científica ao longo desses 10 anos (1,4,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) . Com base em diversos estudos científicos (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) , um programa de atividade física bem orientado traz benefícios aos soropositivos, como: aumento de linfócitos T CD4+, aumento e manutenção do consumo máximo de oxigênio (VO 2máx ), aumento da resistência anaeróbia, aumento da massa e força muscular, redução do percentual de gordura, melhora no perfil lipídico, normalização do índice glicêmico, redução dos fatores de risco coronarianos, melhora da autoestima e qualidade de vida.…”