Factores de riesgo cardiovascular dependientes del paciente en población con infección por VIH | Enfermedades Infecciosas y Microbiología Clínica

Article information

Resumen

La patogenia de la arteriosclerosis en pacientes con infección por virus de la inmunodeficiencia humana (VIH) es compleja, y en ella intervienen tanto los factores deriesgo cardiovascular (FRCV) establecidos para la población general y dependientes del paciente, como los relacionados con el tratamiento antirretroviral de gran actividad (TARGA) y el propio VIH. Algunos de los FRCV tradicionales son más frecuentes en pacientes con infección por VIH queen población general. En países desarrollados predominan los varones con infección por VIH y gracias al TARGA su esperanza de vida ha aumentado deforma significativa. La prevalencia de tabaquismo (37-72%) es mayor que en población general, como también la de diabetes mellitus (17%), resistencia insulínica (17-51%), dislipemia (22-49%) e hipertrigliceridemia (34%). La mayor prevalencia en estos pacientes dependería de los propios estilos de vida y del tiempo de exposición al TARGA, especialmente a determinados fármacos antirretrovirales. Aunque el riesgo cardiovascular global en pacientes con infección por VIH permanece bajo, los FRCV establecidos para población general irán cobrando una mayor importancia conform e vaya aumentando progresivamente la edad de los pacientes. Estudios longitudinales de cohortes señalan la magnitud de asociación de estos factores de riesgo con la enfermedad cardiovascular en pacientes con infección por VIH. Teniendo en cuenta todos los factores que intervienen en la infección por VIH, deben diseñarse modelos matemáticos específicos para esta población que permitan calcular el RCV individual de cada paciente y establecer medidas de prevención cardiovascular.

Palabras clave:

Enfermedad cardiovascular

VIH

Factores de riesgo

Abstract

The pathogenesis of arteriosclerosis in HIV-infected patients is complex. Both patient-related cardiovascular risk factors (CVRF) established for the general population and those related to highly-active antiretroviral therapy (HAART) and HIV infection per se are involved. Some traditional CVRF are more frequent in HIVinfected patients than in the general population. In developed countries, HIV infection is more frequent among men and, due to HAART, their life expectancy has significantly increased. The prevalence of smoking (37-72%) is higher than in the general population, as is that of diabetes mellitus (17%), insulin resistance (17-51%), dyslipidemia (22-49%) and hypertriglyceridemia (34%). The higher prevalence in these patients is probably due to lifestyle and length of exposure to HAART, especially to certain antiretroviral drugs. Although overall cardiovascular risk in patients with HIV remains low, CVRF established for the general population become more important with increasing age. Longitudinal cohort studies indicate the magnitude of the association of these risk factors with cardiovascular disease in patients with HIV infection. In view of all the factors that intervene in HIV infection, specific mathematical models should be designed for this population that would allow individual cardiovascular risk to be calculated in each patient and measures for cardiovascular prevention to be established.

Keywords:

Cardiovascular disease

HIV

Risk factors

Full text is only aviable in PDF

Bibliografía

[1.]

N. Friis-Møller, C.A. Sabin, R. Weber, A. D’Arminio Monforte, W.M. El-Sadr, P. Reiss, et al.

Combination antiretroviral therapy and the risk of myocardial infarction.

N Engl J Med, 349 (2003), pp. 1993-2003

http://dx.doi.org/10.1056/NEJMoa030218 | Medline

[2.]

S.D. Holmberg, A.C. Moorman, J.M. Williamson, T.C. Tong, D.J. Ward, K.C. Wood, et al.

Protease inhibitors and cardiovascular outcomes in patients with HIV-1.

Lancet, 360 (2002), pp. 1747-1748

http://dx.doi.org/10.1016/S0140-6736(02)11672-2 | Medline

[3.]

M. Mary-Krause, L. Cotte, A. Simon, M. Partisani, D. Costagliola.

Clinical Epidemiology Group from the French Hospital Database. Increased risk of myocardial infarction with duration protease inhibitor therapy in HIV infected men.

AIDS, 17 (2003), pp. 2479-2486

http://dx.doi.org/10.1097/01.aids.0000096857.36052.23 | Medline

[4.]

N. Friis-Møller, P. Reiss, C.A. Sabin, R. Weber, A. Monforte, W. El-Sadr, et al.

for the DAD Study Group. Class of Antiretroviral Drugs and the risk of Myocardial Infarction.

N Eng J Med, 356 (2007), pp. 1723-1735

[5.]

C.A. Sabin, S.W. Worm, R. Weber, P. Reiss, W. El-Sadr, F. Dabis, et al.

Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: a multi-cohort collaboration.

Lancet, 37 (2008), pp. 1417-1426

[6.]

P.W. Wilson, R.B. D’Agostino, D. Levy, A.M. Belanger, H. Silbershatz, W.B. Kannel.

Prediction of coronary heart disease using risk factor categories.

Circulation, 97 (1998), pp. 1837-1847

Medline

[7.]

2007 Guidelines for the management of arterial hypertension.

The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

Eur Heart J, 28 (2007), pp. 1462-1536

http://dx.doi.org/10.1093/eurheartj/ehm236 | Medline

[8.]

I. Graham, D. Atar, K. Borch-Johnsen, G. Boysen, G. Burell, R. Cifkova, et al.

European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice.

Eur Heart J, 19 (2007), pp. 2375-2414

[9.]

Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106:3143-421.

[10.]

Lang S, Mary-Krause M, Cotte L, Gilquin J, Patisani M, Simon A, et al. Impact of specific NRTI and PI on the risk of Myocardial infarction: a case-control study nested within FHDH ANRS CO4. 16th Conference on Retroviruses and Opportunistic Infections. Montreal; February 8-11, 2009. Abstract 43LB.

[11.]

C.J. Smith, I. Levy, C.A. Sabin, E. Kaya, M.A. Johnson, M.C. Lipman.

Cardiovascular risk factors and antiretroviral therapy in an HIV UK population.

HIV Med, 5 (2004), pp. 88-92

Medline

[12.]

J. Santos, R. Palacios, M. González, J. Ruiz, M. Márquez.

Atherogenic lípido profile and cardiovascular risk factors in HIV-infected patients (Netar Stody).

In J STD AIDS, 16 (2005), pp. 677-680

[13.]

T.R. Glass, C. Ungsedhapand, M. Wolbers, R. Weber, P.L. Vernazza, M. Rickenbach, et al.

Prevalence of risk factors for cardiovascular disease in HIV-infected patients over time: the Swiss HIV Cohort Study.

HIV Med, 7 (2006), pp. 404-410

http://dx.doi.org/10.1111/j.1468-1293.2006.00400.x | Medline

[14.]

R.C. Kaplan, L.A. Kingsley, A.R. Sharrett, X. Li, J. Lazar, P.C. Tien, et al.

Ten-year predicted coronary heart disease risk in HIV-infected men and women.

Clin Infect Dis, 45 (2007), pp. 1074-1081

http://dx.doi.org/10.1086/521935 | Medline

[15.]

J. Oh, R.A. Hegele.

HIV-associated dyslipidemia: pathogenesis and treatment.

Lancet Inf Dis, 7 (2007), pp. 787-796

[16.]

N. Friis-Møller, R. Weber, P. Reiss, R. Thiébaut, O. Kirk, A. D’Arminio Monforte, et al.

Cardiovascular disease risk factors in HIV patients--association with antiretroviral therapy. Results from the DAD study.

AIDS, 17 (2003), pp. 1179-1193

http://dx.doi.org/10.1097/01.aids.0000060358.78202.c1 | Medline

[17.]

A. Khalsa, R. Karim, W.J. Mack, H. Minkoff, M. Cohen, M. Young, et al.

Correlates of prevalent hypertension in a large cohort of HIV-infected women: Women's Interagency HIV Study.

AIDS, 21 (2007), pp. 2539-2541

[18.]

M. Savès, G. Chêne, P. Ducimetière, C. Leport, G. Le Moal, P. Amouyel, et al.

Risk factors for coronary heart disease in patients treated for human immunodeficiency virus infection compared with the general population.

Clin Infect Dis, 37 (2003), pp. 292-298

http://dx.doi.org/10.1086/375844 | Medline

[19.]

C.A. Sabin, A. D’Arminio Monforte, N. Friis-Moller, R. Weber, W.M. El-Sadr, P. Reiss, et al.

Changes over time in risk factors for cardiovascular disease and use of lipidlowering drugs in HIV-infected individuals and impact on myocardial infarction.

Clin Infect Dis, 46 (2008), pp. 1101-1110

http://dx.doi.org/10.1086/528862 | Medline

[20.]

E.C. Seaberg, A. Muñoz, M. Lu, R. Detels, J.B. Margolick, S.A. Riddler, et al.

Association between highly active antiretroviral therapy and hypertension in a large cohort of men followed from 1984 to 2003.

AIDS, 19 (2005), pp. 953-960

Medline

[21.]

G.M. Reaven.

Insulin resistance/compensatory hyperinsulinemia, essential hypertension and cardiovascular disease.

J Clin Endocrinol Metab, 88 (2003), pp. 2399-2403

http://dx.doi.org/10.1210/jc.2003-030087 | Medline

[22.]

M. Pyorala, H. Miettinen, M. Laakso, K. Pyorala.

Hyperinsulinaemia predicts coronary heart disease risk in healthy middle-aged men: the 22 year follow-up results of the Helsinky Policemen Study.

Circulation, 98 (1998), pp. 398-404

Medline

[23.]

T.T. Brown, S.R. Cole, X. Li, L.A. Kingsley, F.J. Palella, S.A. Riddler, et al.

Antiretroviral therapy and the prevalence and incidence of diabetes mellitus in the multicenter AIDS cohort study.

Arch Intern Med, 165 (2005), pp. 1179-1184

http://dx.doi.org/10.1001/archinte.165.10.1179 | Medline

[24.]

K. Samaras, H. Wand, M. Law, S. Emery, D. Cooper, A. Carr.

Prevalence of metabolic syndrome in HIV-infected patients receiving highly active antirretroviral therapy using International Diabetes Foundation and Adult Treatment Panel III Criteria.

Diabetes Care, 30 (2007), pp. 113-119

http://dx.doi.org/10.2337/dc06-1075 | Medline

[25.]

C. Jericó, H. Knobel, M. Montero, J. Ordóñez-Llanos, A. Guelar, J.L. Gimeno, et al.

Metabolic syndrome among HIV-infected patients.

Diabetes Care, 28 (2005), pp. 144-149

[26.]

K. Mondy, E.T. Overton, J. Grubb, S. Tong, W. Seyfried, W. Powderly, et al.

Metabolic syndrome in HIV-infected patients from an urban, Midwestern US outpatient population.

Clin Infect Dis, 44 (2007), pp. 726-734

http://dx.doi.org/10.1086/511679 | Medline

[27.]

T. Joy, H.M. Keogh, C. Hadigan, H. Lee, S.E. Dolan, K. Fitch, et al.

Dietary fat intake and relationship to serum lipid levels in HIV-infected patients with metabolic abnormalities in the HAART era.

AIDS, 21 (2007), pp. 1591-1600

http://dx.doi.org/10.1097/QAD.0b013e32823644ff | Medline

[28.]

B. Lau, A.R. Sharrett, L.A. Kingsley, W. Post, F.J. Palella, B. Visscher, et al.

C-reactive protein is a marker for human immunodeficiency virus disease progression.

Arch Intern Med, 166 (2006), pp. 64-70

http://dx.doi.org/10.1001/archinte.166.1.64 | Medline

[29.]

K. Hernia, D. Kitchb, M. Dubec, R. Zackinb, R.A. Parkerb, D. Sprecherd, et al.

C-reactive protein levels over time and cardiovascular risk in HIV-infected individuals suppressed on an indinavir-based regimen: AIDS Clinical Trials Group 5056s.

AIDS, 18 (2004), pp. 2434-2437

Medline

[30.]

J.G. Feldman, P. Goldwasser, S. Colman, J. DeHovitz, H. Minkoff.

C-reactive protein is an independent predictor of mortality in women with HIV-1 infection.

J Acquir Immune Defic Syndr, 32 (2003), pp. 210-214

Medline

[31.]

V.A. Triant, J.B. Meigs, S.K. Grinspoon.

Association of C-reactive protein and HIV infection with acute myocardial infarction.

J Acquir Immune Defic Syndr, 51 (2009), pp. 268-273

http://dx.doi.org/10.1097/QAI.0b013e3181a9992c | Medline

[32.]

M. Bekken, I. Os, L. Sandvik, O. Oektedalen.

Microalbuminuria associated with indicators of infl amatory activity in an HIV-positive population.

Nephrol Dial Transplant, 23 (2008), pp. 3130-3137

http://dx.doi.org/10.1093/ndt/gfn236 | Medline

[33.]

O. Moreno-Pérez, A. Picó Alfonso, J. Portilla.

Hipogonadismo, disfunción eréctil y disfunción endotelial en varones con infección por el VIH.

Med Clin, 132 (2009), pp. 311-321

[34.]

D.G. Hackam, S.S. Anand.

Emerging risk factors for atherosclerotic vascular disease. A critical review of the evidence.

JAMA, 290 (2003), pp. 932-940

http://dx.doi.org/10.1001/jama.290.7.932 | Medline

[35.]

G. Guaraldi, P. Ventura, E. Garlassi, G. Orlando, N. Squillace, G. Nardini, et al.

Hyperhomocysteinaemia in HIV-infected patients: determinants of variability and correlations with predictors of cardiovascular disease.

HIV Med, 10 (2009), pp. 28-34

http://dx.doi.org/10.1111/j.1468-1293.2008.00649.x | Medline

[36.]

V.V. Joshi, B. Pawel, E. Connor, L. Sharer, J.M. Oleske, S. Morrison, et al.

Arteriopathy in children with acquired immunodeficiency syndrome.

Pediatr Pathol, 7 (1987), pp. 26-75

[37.]

K. De Gaetano Donati, R. Rabagliati, L. Iacoviello, R. Cauda.

HIV infection, HAART and endothelial adhesión molecules: current perspectives.

Lancet Infectious Dis, 4 (2004), pp. 213-222

[38.]

M.G. Shlipak, J.H. Ix, K. Bibbins-Domingo, F. Lin, M.A. Whooley.

Biomarkers to predict recurrent cardiovascular disease: the Heart and Soul Study.

Am J Med, 121 (2008), pp. 50-57

[39.]

L.H. Kuller, R. Tracy, W. Belloso, S. De Wit, F. Drummond, H.C. Lane, et al.

Infl ammatory and coagulation biomarkers and mortality in patients with HIV infection.

PLoS Med, 5 (2008), pp. e203

http://dx.doi.org/10.1371/journal.pmed.0050203 | Medline

[40.]

A. Prasad, J. Zhu, J.P. Halcox, M.A. Waclawiw, S.E. Epstein, A.A. Quyyumi.

Predisposition to atherosclerosis by infections: role of endothelial dysfunction.

Circulation, 106 (2002), pp. 184-190

Medline

[41.]

M. Seigneur, J. Constans, A. Blann, M. Renard, J.L. Pellegrin, J. Amiral, et al.

Soluble adhesión molecules and endothelial cell damage in HIV infected-patients.

Thromb Haemost, 77 (1997), pp. 646-649

Medline

[42.]

M.W. Lorenz, S. Von Kegler, H. Steinmetz, H.S. Markus, M. Sitzer.

Carotid intima-media thickening indicates a higher vascular risk across a wide age range: prospective data from the Carotid Atherosclerosis Progression Study (CAPS).

Stroke, 37 (2006), pp. 87-92

http://dx.doi.org/10.1161/01.STR.0000196964.24024.ea | Medline

[43.]

M.W. Lorenz, H.S. Markus, M.L. Bots, M. Rosvall, M. Sitzer.

Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis.

Circulation, 115 (2007), pp. 459-467

http://dx.doi.org/10.1161/CIRCULATIONAHA.106.628875 | Medline

[44.]

P.Y. Hsue, J.C. Lo, A. Franklin, A.F. Bolger, J.N. Martin, S.G. Deeks, et al.

Progression of Atherosclerosis as Assessed by carotid Intima-Media Thickness in patients with HIV infection.

Circulation, 109 (2004), pp. 1603-1608

http://dx.doi.org/10.1161/01.CIR.0000124480.32233.8A | Medline

[45.]

J.S. Currier, M.A. Kendall, W.K. Henry, B. Alston-Smith, F.J. Torriani, P. Tebas, et al.

Progression of carotid artery intima-media thickening in HIV-infected and uninfected adults.

AIDS, 21 (2007), pp. 1137-1145

http://dx.doi.org/10.1097/QAD.0b013e32811ebf79 | Medline

[46.]

P. Maggi, F. Perilli, A. Lillo, M. Gargiulo, S. Ferraro, B. Grisorio, et al.

Rapid progression of carotid lesions in HAART-treated HIV-1 patients.

Atherosclerosis, 192 (2007), pp. 407-412

http://dx.doi.org/10.1016/j.atherosclerosis.2006.05.026 | Medline

[47.]

R. Roberts.

Genetics of premature myocardial infarction.

Curr Atheroscler Rep, 10 (2008), pp. 186-193

Medline

[48.]

A. Helgadottir, A. Manolescu, G. Thorleifsson, S. Gretarsdottir, H. Jonsdottir, U. Thorsteinsdottir, et al.

The gene encoding 5-lipoxygenase activating protein confers risk of myocardial infarction and stroke.

Nat Genet, 36 (2004), pp. 233-239

http://dx.doi.org/10.1038/ng1311 | Medline

[49.]

K. Ranade, W.J. Geese, M. Noor, O. Flint, P. Tebas, K. Mulligan, et al.

Genetic analysis implicates resistin in HIV lipodystrophy.

AIDS, 22 (2008), pp. 1561-1568

http://dx.doi.org/10.1097/QAD.0b013e32830a9886 | Medline

[50.]

M. Guardiola, R. Ferré, J. Salazar, C. Alonso-Villaverde, B. Coll, S. Parra, et al.

Protease inhibitor-associated dyslipidemia in HIV-infected patients is strongly infl uenced by the APOA5-1131T->C gene variation.

Clin Chem, 52 (2006), pp. 1914-1919

http://dx.doi.org/10.1373/clinchem.2006.069583 | Medline

[51.]

M.G. Law, N. Friis-Moller, W.M. El-Sadr, R. Weber, P. Reiss, A. D’Arminio Monforte, et al.

The use of the Framingham equation of predict myocardial infarctions in HIVinfected patients: comparison with observed events in the D:A:D study.

HIV Med, 7 (2006), pp. 218-230

http://dx.doi.org/10.1111/j.1468-1293.2006.00362.x | Medline

Indexed in:

Follow us:

Subscribe:

Indexed in:

Follow us:

Subscribe:

Subscribe to our newsletter