October - December 2018

Overcoming Obstacles in Lipid-lowering Therapy in Patients with HIV - A Systematic Review of Current Evidence

Abstract

Cardiovascular risk management in human immunodeficiency virus (HIV)-infected individuals is gaining increased attention due to the rising incidence and prevalence of cardiovascular disease in this population. Despite the availability of efficacious treatment strategies, implementation of guideline advocated preventive therapy, such as lipid-lowering therapy with statins, is hampered by perceived, expected, and real side effects as well as by expected interactions with combination antiretroviral therapy. These obstacles to optimal treatment have resulted in a large gap between the number of patients in whom lipidlowering therapy is indicated and those actually taking lipid-lowering medication. In the past few years, research has shown that the majority of patient-reported side effects is not causally related to statin therapy but is attributable to the nocebo effect. Furthermore, excessive caution due to expected drug interactions between statins and antiretroviral therapy is often unnecessary, especially with novel classes of antiretroviral therapy. The main aim of this review is to discuss the causes and consequences of this lipid-lowering treatment gap in HIV-infected patients together with a practical guide on how to overcome these obstacles. In addition, new treatment options on the optimal cardiovascular management focusing primarily on novel classes of antiretroviral therapy and lipid-lowering medication will be discussed.

Keywords:
Human immunodeficiency virus infection. Cardiovascular risk. Statin. Integrase strand transfer inhibitor. Proprotein convertase subtilisin kexin-9 inhibitor.