Factores de riesgo cardiovascular dependientes del paciente en población con infección por VIH

Portilla, Joaquín

doi:10.1016/S0213-005X(09)73440-8

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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

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