Información del artículo
Resumen
Hay múltiples evidencias de que los pacientes infectados por el virus de la inmunodeficiencia humana (VIH), tanto varones como mujeres y tanto adultos como niños, tienen un mayor riesgo de desarrollar enfermedad cardiovascular arteriosclerótica. Dichas evidencias provienen tanto de estudios cuyas variables primarias han sido las propias manifestaciones clínicas de enfermedad cardiovascular arteriosclerótica (infarto agudo de miocardio, isquemia miocárdica silente, accidente vasculocerebral [AVC] y arteriopatía periférica), como diversos marcadores de aterosclerosis prematura y disfunción endotelial determinados a distintos niveles (carótidas, coronarias o arterias periféricas) y con diferentes procedimientos diagnósticos (EIM, CAC, FMD, rigidez arterial, índice tobillo/brazo, etc.). Este exceso de riesgo de enfermedad cardiovascular arteriosclerótica de los pacientes VIH-positivos está manifiestamente asociado con la propia infección por el VIH y con los factores de riesgo cardiovascular clásicos y, de forma menos relevante y homogénea, con el uso de inhibidores de la proteasa de primera generación. La hipertensión arterial, cuya relación con la infección por el VIH es mucho menos clara, se asocia, además de con los factores de riesgo cardiovascular tradicionales, con la existencia de lipodistrofia.
Palabras clave:
Infección por VIH
Riesgo cardiovascular
Arteriosclerosis
Cardiopatía isquémica
Abstract
A large body of evidence indicates that HIV-infected patients, both men and women, as well as adults and children, have a higher risk of developing arteriosclerotic cardiovascular disease. This evidence comes from studies whose main primary variables were the clinical manifestations of arteriosclerotic cardiovascular disease (acute myocardial infarction, silent myocardial ischemia, stroke and peripheral arterial disease) and the distinct markers of premature atherosclerosis and endothelial dysfunction determined in different sites (carotid, coronary or peripheral arteries) and with distinct diagnostic procedures (carotid intimamedia thickening, coronary artery calcification, flow-mediated vasodilation, arterial rigidity, ankle/arm index, etc.). This excess risk of arteriosclerotic cardiovascular disease in HIV-positive patients is clearly associated with the HIV infection per se and with classical cardiovascular risk factors, and, to a lesser extent and less uniformly, with the use of first-generation protease inhibitors. Hypertension, whose association with HIV infection is far less clear, is related to both traditional cardiovascular risk factors and to lipodystrophy.
Keywords:
HIV infection
Cardiovascular risk
Arteriosclerosis
Ischemic heart disease
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