Riesgo vascular en pacientes con infección crónica por el VIH-1: controversias con implicaciones terapéuticas, clínicas y pronósticas

Dronda, Fernando

doi:10.1016/S0213-005X(04)73029-3

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La aterosclerosis incrementa el riesgo cardiovascular y la posibilidad de desarrollar un infarto agudo de miocardio (IAM) o un ictus. Los pacientes con infección por el virus de la inmunodeficiencia humana (VIH) presentan con frecuencia alteraciones morfológicas y alteraciones metabólicas (hipercolesterolemia, hipertrigliceridemia, resistencia insulínica, diabetes) que podrían incrementar el riesgo vascular. La frecuente coexistencia de factores de riesgo clásico (dieta aterogénica, tabaquismo, inactividad física, consumo de cocaína), el progresivo incremento de la edad media de los pacientes infectados por el VIH-1 y la polimedicación que reciben, dificulta la estimación del efecto directo que las nuevas terapias pudieran tener sobre este riesgo. Amplios estudios clínicos de cohortes, de naturaleza retrospectiva y diseños diversos, ofrecen resultados contradictorios sobre el riesgo vascular de la población con infección por el VIH. Se precisa un mayor período de observación, y controlar el efecto de los otros factores de riesgo clásico, para depurar el posible efecto deletéreo que las nuevas terapias pudieran tener sobre el riesgo cardiovascular.

Palabras clave:

Dislipemia

Infección por el VIH

Riesgo cardiovascular

Ictus

Infarto de miocardio

Factores deriesgo

Atherosclerosis increases cardiovascular risk and the possibility of developing acute myocardial infarction (AMI) or stroke. Patients infected with human immunodeficiency virus (HIV) often present morphological and metabolic alterations (hypercholesterolemia, hypertriglyceridemia, insulin resistance, diabetes) that can increase vascular risk. The frequent coexistence of classic risk factors (atherogenic diet, smoking, physical inactivity, cocaine abuse), the progressive increase in mean age of HIV-1 infected patients, and the polymedication they receive make it difficult to estimate the direct effect that new therapies may have on cardiovascular risk. Retrospective clinical studies with diverse designs in large cohorts offer contradictory results for cardiovascular risk in the HIV-infected population. Longer observational periods are needed and the effect of other classic risk factors needs to be controlled, in order to establish the possible detrimental effect the new therapies may have on cardiovascular risk in this population.

Key words:

Dyslipidemia

HIV-infected

Cardiovascular risk

Stroke

Myocardial infarction

Risk factors

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