Dyslipidemia, Atherosclerosis and Cardiovascular Disease: An Increasingly Important Triad in an Aging Population Living with HIV

O’Halloran, Jane A.; Satchell, Claudette; Mallon, Patrick

doi:10.2217/fvl.13.87

Cited by 10 publications

(11 citation statements)

References 109 publications

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“…[1][2][3][4][5][6][7][8][9][10][11][12] Such non-HIV associated conditions have emerged as the leading causes of mortality among persons living with HIV, and among these, cardiovascular disease (CVD) has become a major health threat. [1][2][3][4][5][11][12][13][14][15][16] In addition to lifestyle risk reduction, a cornerstone of CVD prevention is the reduction in atherogenic lipids, chiefly low-density lipoprotein (LDL) cholesterol, and 3-hydroxy-3-methylglutaryl-coenzyme A (HMG)-reductase inhibitors (i.e., statins) are very effective in lowering LDL cholesterol. 17 Use of statins by people with HIV (PWH) has increased; 18-21 yet it remains unclear whether these medications are prescribed equally to those with and without HIV infection when indicated-particularly among minority women.…”

Section: Introductionmentioning

confidence: 99%

Underutilization of Statins When Indicated in HIV-Seropositive and Seronegative Women

Todd

Cole

Wohl

et al. 2017

AIDS Patient Care and STDs

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Increased life expectancy of persons living with HIV infection receiving antiretroviral therapy heightens the importance of preventing and treating chronic comorbidities such as cardiovascular disease. While guidelines have increasingly advocated more aggressive use of statins for low-density lipoprotein (LDL) cholesterol reduction, it is unclear whether people with HIV, especially women, are receiving statins when indicated, and whether their HIV disease is a factor in access. We assessed the cumulative incidence of statin use after an indication in the Women's Interagency HIV Study (WIHS), from 2000 to 2014. Additionally, we used weighted proportional hazards regression to estimate the effect of HIV serostatus on the time to initiation of a statin after an indication. Cumulative incidence of statin use 5 years after an indication was low: 38% in HIV-seropositive women and 30% in HIV-seronegative women. Compared to HIV-seronegative women, the weighted hazard ratio for initiation of a statin for HIV-seropositive women over 5 years was 0.94 [95% confidence interval (CI) 0.62, 1.43]. Applying the American College of Cardiology and the American Heart Association (ACC/AHA) guidelines increased the proportion of HIV-seropositive women with a statin indication from 16% to 45%. Clinicians treating HIV-seropositive women should consider more aggressive management of the dyslipidemia often found in this population.

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Section: Introductionmentioning

confidence: 99%

Underutilization of Statins When Indicated in HIV-Seropositive and Seronegative Women

Todd

Cole

Wohl

et al. 2017

AIDS Patient Care and STDs

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“…PLWHIV have a higher burden and risk of chronic kidney disease, osteoporosis and fracture risk, diabetes and cardiovascular disease, and neurocognitive disorders, and an increased risk for several malignancies, as compared with the general population [9][10][11][12][13][14][15]. This propensity for disease risk and comorbidities is driven not just by ageing but by a continuum of risks in PLWHIV, including risks conferred by HIV infection itself, the impact of comorbidities, copathogens, lifestyle choices linked to health risks, and the known off-target effects of ART that may affect renal, bone and cardiovascular health [8,10,[16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Switching regimens in virologically suppressed HIV‐1‐infected patients: evidence base and rationale for integrase strand transfer inhibitor (INSTI)‐containing regimens

Raffi¹,

Eßer

Nunnari

et al. 2016

HIV Medicine

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In an era when most individuals with treated HIV infection can expect to live into old age, clinicians should proactively review their patients' current and future treatment needs and challenges. Clinical guidelines acknowledge that, in the setting of virological suppression, treatment switch may yield benefits in terms of tolerability, regimen simplification, adherence, convenience and long-term health considerations, particularly in the context of ageing. In this paper, we review evidence from six key clinical studies on switching virologically suppressed patients to regimens based on integrase strand transfer inhibitors (INSTIs), the antiretroviral class increasingly preferred as initial therapy in clinical guidelines. We review these studies and focus on the virological efficacy, safety, and tolerability of switching to INSTI-based regimens in suppressed HIV-positive individuals. We review the early switch studies SWITCHMRK and SPIRAL [assessing a switch from a ritonavir-boosted protease inhibitor (PI/r) to raltegravir (RAL)-containing regimens], together with data from STRATEGY-PI [assessing a switch to elvitegravir (EVG)-containing regimens; EVG/cobicistat (COBI)/emtricitabine (FTC)/tenofovir disoproxil fumarate (TDF) vs. remaining on a PI/r-containing regimen], STRATEGY-NNRTI [assessing a switch to EVG/COBI/FTC/TDF vs. continuation of a nonnucleoside reverse transcriptase inhibitor (NNRTI) and two nucleoside reverse transcriptase inhibitors (NRTIs)], STRIIVING [assessing a switch to a dolutegravir (DTG)-containing regimen (abacavir (ABC)/lamivudine (3TC)/DTG) vs. staying on the background regimen], and GS study 109 [assessing a switch to EVG/COBI/FTC/tenofovir alafenamide fumarate (TAF) vs. continuation of FTC/TDF-based regimens]. Switching to INSTI-containing regimens has been shown to support good virological efficacy, with evidence from two studies demonstrating superior virological efficacy for a switch to EVG-containing regimens. In addition, switching to INSTI regimens was associated with improved tolerability and greater reported patient satisfaction and outcomes in some studies. INSTI-based regimens offer an important contemporary switch option that may be tailored to meet and optimize the needs of many patients.

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“…HIV infection is associated with an increased risk of cardiovascular disease (CVD), a leading cause of death in HIV‐positive individuals on effective antiretroviral therapy (ART) [1]. Several factors contribute to increased CVD risk in this population, including a higher prevalence of traditional risk factors, adverse effects of ART and the specific effects of HIV infection itself [2,3].…”

Section: Introductionmentioning

confidence: 99%

The effect of initiation of antiretroviral therapy on monocyte, endothelial and platelet function in HIV‐1 infection

et al. 2015

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Dyslipidemia, Atherosclerosis and Cardiovascular Disease: An Increasingly Important Triad in an Aging Population Living with HIV

Cited by 10 publications

References 109 publications

Underutilization of Statins When Indicated in HIV-Seropositive and Seronegative Women

Underutilization of Statins When Indicated in HIV-Seropositive and Seronegative Women

Switching regimens in virologically suppressed HIV‐1‐infected patients: evidence base and rationale for integrase strand transfer inhibitor (INSTI)‐containing regimens

The effect of initiation of antiretroviral therapy on monocyte, endothelial and platelet function in HIV‐1 infection

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