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En la actualidad se sabe que la exposición al tratamiento antirretroviral, particularmente a los inhibidores de proteasa clásicos, se asocia con un incremento del riesgo de presentar enfermedad cardiovascular, aunque la interrupción del tratamiento antirretroviral puede ocasionar un riesgo aún mayor. Se han emitido recomendaciones sobre la intervención ante la dislipidemia y el riesgo cardiovascular en personas seropositivas. Estas recomendaciones se semejan a las de la población general, pero incluyen el carácter particular de considerar incluir un tratamiento antirretroviral benigno con los lípidos en la medida de lo posible.
Atazanavir presenta unas características diferentes de las de otros inhibidores de la proteasa en cuanto a sus efectos sobre el tejido adiposo y el metabolismo en general. Atazanavir no se ha asociado con los aumentos de las concentraciones de colesterol total, colesterol unido a lipoproteínas de baja densidad (cLDL) o triglicéridos que han presentado otros inhibidores de la proteasa en pautas de inicio, rescate o simplificación. Los resultados de los estudios in vitro y clínicos son claros y contundentes.
Estas características le confieren un papel singular muy atractivo a la hora de decidir el tratamiento antirretroviral más adecuado para una proporción de pacientes infectados por el virus de la inmunodeficiencia humana (VIH) en los que la reducción del riesgo cardiovascular constituya una prioridad.
Palabras clave:
Atazanavir
Hiperlipidemia
Riesgo cardiovascular
It is currently known that exposure to antiretroviral treatment, particularly to the classic protease inhibitors, is associated with an increased risk of suffering from cardiovascular disease, although stopping antiretroviral treatment can cause an even greater risk. Recommendations have been made on how to deal with dyslipaemia and cardiovascular risk in seropositive patients. These recommendations are similar to those for the general population, but include the particular feature of considering including benign treatment with lipids wherever possible.
Atazanavir has different characteristics from other protease inhibitors as regards its effects on adipose tissue and metabolism in general. Atazanavir is not associated with increases in total cholesterol, LDL-cholesterol or triglycerides as with other PI in initial, rescue or simplification therapy. The results of in vitro studies and clinical studies are clear and convincing. These characteristics give it a particular role that is very attractive when deciding the most suitable antiretroviral treatment for a proportion of HIV-infected patients in whom the reduction in cardiovascular risk is seen as a priority.
Key words:
Atazanavir
Hyperlipaemia
Cardiovascular risk
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