Guidelines for the Evaluation and Management of Dyslipidemia in Human Immunodeficiency Virus (HIV)-Infected Adults Receiving Antiretroviral Therapy: Recommendations of the HIV Medicine Association of the Infectious Disease Society of America and the Adult AIDS Clinical Trials Group

Dubé, Michael P.; Stein, James H.; Aberg, Judith A.; Fichtenbaum, Carl J.; Gerber, John G.; Tashima, Karen T.; Henry, W. Keith; Currier, Judith S.; Sprecher, Dennis L.; Glesby, Marshall J.

doi:10.1086/378131

Cited by 551 publications

(553 citation statements)

References 117 publications

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“…Most parameters of HDL metabolism, however, were not affected by the treatment regimens used in this study, suggesting a limited impact of these compounds on HDL metabolism. This finding is consistent with other reports [30,31], but cannot be extended to all classes of antiretroviral therapy. Another limitation is that only males were included in this study; differences between males and females in responding to HAART have been described [31].…”

Section: Discussionsupporting

confidence: 93%

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HIV infection and high density lipoprotein metabolism

et al. 2008

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HIV infection and its treatment are associated with dyslipidemia, including hypoalphalipoproteinemia, and increased risk of cardiovascular disease. Parameters of HDL metabolism in HIV-positive patients were investigated in a cross-sectional study. The following groups of subjects were selected: i) 25 treatment-naïve HIV-infected patients or HIV-infected patients on long therapy break, ii) 28 HIV-infected patients currently treated with protease inhibitors, and iii) 33 HIV-negative subjects. Compared to the HIV-negative group, all groups of HIV-infected patients were characterized by significantly elevated triglyceride and apolipoprotein B levels, mass and activity of lecithin cholesterol acyl transferase and cholesteryl ester transfer protein (p<0.01). Total and LDL cholesterol was lower in treatment-naïve HIV-infected group only. HDL cholesterol and preβ 1 -HDL were significantly lower in all HIV-infected groups (p<0.05), while mean levels of apolipoprotein A-I (apoA-I) and ability of plasma to promote cholesterol efflux were similar in all groups. We found a positive correlation between apoA-I and levels of CD4+ cells (r 2 = 0.3, p<0.001). Plasma level of phospholipid transfer protein was reduced in the group on antiretroviral therapy. Taken together these results suggest that HIV infection is associated with modified HDL metabolism re-directing cholesterol to the apoB-containing lipoproteins and likely reducing the functionality of reverse cholesterol transport.

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Section: Discussionsupporting

confidence: 93%

“…A limitation of this study is that HIV-infected patients were treated with various antiretroviral regimens that may have different impact on lipid metabolism [30]. Most parameters of HDL metabolism, however, were not affected by the treatment regimens used in this study, suggesting a limited impact of these compounds on HDL metabolism.…”

Section: Discussionmentioning

confidence: 90%

HIV infection and high density lipoprotein metabolism

et al. 2008

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“…The interest to determine non-HDL-C is the existing of specific goal defined by the NCEP-ATPIII guidelines as LDL-C target + 30 mg/dl (+ 0.77 mmol/l) in the general population 25 . The ACTG/IDSA lipid guidelines mentioned the non-HDL-C level as a secondary therapeutic target after LDL-C for HIV+ patients with TG ranging from 2 g/l to 5 g/l (2.3 to 5.6 mmol/l) 40 . In our study, mean LDL-C (3.3 ± 1.1 mmol/l) was equal to the primary prevention cut-off of 130 mg/dl (3.3 mmol/l) and was independent of the presence of MS or LT. By contrast non-HDL-C appears dependent to metabolic parameters and overwhelmed the threshold value of 4.1 mmol/l (160 mg/dl) in case of MS or LT presence.…”

Section: Discussionmentioning

confidence: 99%

Association of non-HDL cholesterol with subclinical atherosclerosis in HIV-positive patients

Badiou

Thiébaut

Aurillac-Lavignolle

et al. 2008

Journal of Infection

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“…19 Consequently, regular CET has been recommended in the guidelines for management of HIV-related dyslipidemia. 20 Several nonrandomized controlled trials of aerobic and resistance exercise studies with small sample sizes and short training durations have reported improvement in lipid and body composition profiles in HIV + individuals with BFR in Western countries. [21][22][23][24][25][26][27] In resource-limited areas such as sub-Saharan Africa, CET may be a particularly important treatment for BFR and metabolic disorders in HIV + individuals taking HAART.…”

Section: Introductionmentioning

confidence: 99%

Exercise Training Reduces Central Adiposity and Improves Metabolic Indices in HAART-Treated HIV-Positive Subjects in Rwanda: A Randomized Controlled Trial

Mutimura

Crowther

Cade

et al. 2008

AIDS Research and Human Retroviruses

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As HAART becomes more accessible in sub-Saharan Africa, metabolic syndromes, body fat redistribution (BFR), and cardiovascular disease may become more prevalent. We conducted a 6-month, randomized controlled trial to test whether cardiorespiratory exercise training (CET), improves metabolic, body composition and cardiorespiratory fitness parameters in HAARTtreated HIV + African subjects with BFR. Six months of CET reduced waist circumference (−7.13 ± 4.4 cm, p < 0.0001), WHR (−0.10 ± 0.1, p < 0.0001), sum skinfold thickness (−6.15 ± 8.2 mm, p < 0.0001) and % body fat mass (−1.5 ± 3.3, p < 0.0001) in HIV + BFR + EXS. Hip circumference was unchanged in non-exercise control groups. CET reduced fasting total cholesterol (−0.03 ± 1.11 mM, p < 0.05), triglycerides (−0.22 ± 0.48 mM, p < 0.05) and glucose levels (−0.21 ± 0.71 mM, p < 0.05) (p < 0.0001). HDL-, LDL-cholesterol and HOMA values were unchanged after CET. Interestingly, HIV + subjects randomized to non-exercising groups experienced increases in fasting plasma glucose levels, whereas HIV seronegative controls did not (p < 0.001). Predicted VO 2 peak increased more in the HIV + BFR + EXS than in all other groups (4.7 ± 3.9 ml/kg/min, p < 0.0001). Exercise training positively modulated body composition and metabolic profiles, and improved cardiorespiratory fitness in HAART-treated HIV + Africans. These beneficial adaptations imply that exercise training is a safe, inexpensive, practical, and effective treatment for evolving metabolic and cardiovascular syndromes associated with HIV and HAART exposure in resource-limited sub-Saharan countries, where treatment is improving, morbidity and mortality rates are declining, but where minimal resources are available to manage HIV-and HAARTassociated cardiovascular and metabolic syndromes.

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Guidelines for the Evaluation and Management of Dyslipidemia in Human Immunodeficiency Virus (HIV)-Infected Adults Receiving Antiretroviral Therapy: Recommendations of the HIV Medicine Association of the Infectious Disease Society of America and the Adult AIDS Clinical Trials Group

Cited by 551 publications

References 117 publications

HIV infection and high density lipoprotein metabolism

HIV infection and high density lipoprotein metabolism

Association of non-HDL cholesterol with subclinical atherosclerosis in HIV-positive patients

Exercise Training Reduces Central Adiposity and Improves Metabolic Indices in HAART-Treated HIV-Positive Subjects in Rwanda: A Randomized Controlled Trial

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