After HIV infection, coupled with long-term medication, many infected patients have dyslipidemia, which greatly increases the risk of cardiovascular disease. Effective management of blood lipids in infected patients requires the cooperation of doctors and patients. Patients need to have regular lipid tests to control the risk and prevent the disease from occurring.
With the prolongation of survival in patients with HIV AIDS,Non-AIDS-defining diseases*,For example, the risk of atherosclerotic cardiovascular disease, chronic liver and kidney disease, and non-AIDS-defining tumors gradually increases. Metabolic abnormalities caused by long-term use of antiviral drugs lead to many complications such as weight gain, dyslipidemia, diabetes, and metabolic syndrome, among which dyslipidemia is the main risk factor for cardiovascular events. Therefore, it is of great significance to actively control the traditional risk factors of ASCVD and strengthen the management of dyslipidemia in patients to reduce the risk of ASCVD (atherosclerotic cardiovascular disease) and improve the long-term prognosis and quality of life of patients.
Non-AIDS-defining diseases*,What is a non-aids-defining disease, or NAD? Refers to what happens to people living with HIV, butIt's notBecause of HIVDirectly causedsuch as atherosclerotic cardiovascular disease, chronic liver and kidney disease, non-AIDS-defining tumors, etc. As antiretroviral disease becomes more widespread and effective, the immune system of people living with HIV is restored, and the risk of many NADs increases before AIDS develops into AIDS syndrome.
Why infected people are more likely to have lipid problems?
According to current research, there are generally three reasons why infected people are prone to dyslipidemia.
Traditional dyslipidemia causes.
Both infected and non-infected people may encounter this kind of cause, mainly hereditary and secondary, to put it simply, it is brought in the mother's womb and made by yourself.
The general causes are family genetics, gender, age, long-term unhealthy diet (high fat, obesity, tobacco and alcohol......）
These causes may lead to increased levels of triglycerides, total cholesterol, LDL cholesterol, etc. in the blood.
Dyslipidemia due to HIV infection.
HIV infection may lead to inflammatory changes and immune activation of fat cells, affect blood lipid metabolism, and cause metabolic disorders such as hypertriglyceridemia and hypoHDL-C emia.
Secondly, it will also promote hepatic gluconeogenesis and induce liver triglyceride secretion through the influence of insulin and other system chains.
Finally, viral infection may also cause damage to cardiomyocytes and vascular endothelium, affecting the circulatory system and increasing the risk of dyslipidemia.
To put it simply, HIV infection will cause a series of changes in the human body, which will cause abnormal blood lipids by affecting the metabolism of substances in the body and organ damage.
Dyslipidemia that may result from long-term use of antiviral drugs.
Long-term medication, especially certain drugs, is more likely to cause abnormalities in blood lipid-related indicators.
The class of antiretroviral drugs most commonly associated with dyslipidemia may be older generation PI (protease inhibitors), which cause markedly elevated levels of TG, TC, and LDL-C. In terms of drug classes, NRTIS and NNTIs (nucleoside and non-nucleoside drugs) mostly elevated TC, LDL C, HDL C, and TG.
What problems can be caused by dyslipidemia
Dyslipidemia is a cardiovascular eventMajor risk factorsElevated cholesterol levels are associated with more than 50% of coronary heart disease worldwide. Under the superposition of several influencing factors, infected patients are more likely to have abnormalities in blood lipids. It is also easy to get closer to cardiovascular and cerebrovascular diseases.
Common cardiovascular and cerebrovascular diseases include: atherosclerotic cardiovascular disease, coronary heart disease, myocardial infarction, stroke, etc.
In the process of contact with an infected person, there are often someWrong perceptionFor example: "I'm very thin, it's unlikely that I'll get the diseases that only those old people get", "I usually eat very healthy, and my blood lipids are unlikely to be abnormal", "I've been exercising, how can I have these problems". However, the reality is that regardless of age, fatness, exercise, and figure, as long as multiple factors are superimposed, any kind of person may have dyslipidemia. Therefore, paying attention to the management of blood lipids to reduce several cardiovascular and cerebrovascular diseases caused by dyslipidemia is an important part of the chronic disease management for every infected patient.
How lipid management is performed.
For people living with HIV, it is necessary to have a proactive awareness of lipid management to prevent the occurrence of HIV. In general, it is necessary to understand the following knowledge of lipid management and actively implement it.
Daily lipid screening in infected patients.
Patients with HIV AIDS who are HIV-infected or receiving ART are dyslipidemiaHigh-risk populations, according to the Chinese Guidelines for the Management of Blood Lipids (2023) for the management of high-risk groups, recommendedBlood lipids are measured every 3 to 6 months。For those who are ready to take medicine, not only should the baseline test check the blood lipids, but also screen to find out whether the family has a history of high cholesterol and early-onset cardiovascular disease.
For example, ASCVD evaluation with dyslipidemia.
At present, the 10-year ASCVD pathogenesis risk assessment protocol of the Chinese Guidelines for the Management of Blood Lipids (2023) is used as the basis for the decision-making of lipid regulation**. A professional doctor will evaluate the patient based on the overall condition and rank the patient according to the risk of ASCVDGradingThe general level is divided into very high-risk, high-risk, medium-risk, and low-risk.
There are many factors involved, including LDL-C HDL-C levels, age, blood pressure, diabetes history, smoking, BMI, and more.
Key targets and targets of dyslipidemia.
LDL C is the primary target of lipid regulation, and dyslipidemia, especially the elevation of LDL C, is a key factor leading to the occurrence and development of ASCVD.
It is recommended that patients with HIV infection and hyperlipidemia have LDL C controlled at least to3.0 mmol/l（116 mg/l）, and downgrade the target based on the ASCVD risk level.
Lipid intervention modalities.
Adjustments to daily life.
Diet** and lifestyle modifications are part of lipid managementBasic measures, with or without drug lipid adjustment**. A good lifestyle includes eating a healthy diet, exercising regularly, quitting smoking, and**. Lifestyle intervention is oneThe most economical and cost-effective** measures. Here are some suggestions:
Low salt and low fat, control total calorie intake, and eat more foods rich in dietary fiber.
Stick to the amount of exercise at noon intensity.
Quit smoking and limit alcohol.
Control your weight to your ideal.
*Program adjustments.
For patients with dyslipidemia who need to change the regimen, drug effectiveness, adverse reactions, and patient compliance need to be comprehensively considered. Different ART drugs have different effects on blood lipids. If the standard of antiviral drugs needs to be adjusted has indeed been met, the professional doctor will make a comprehensive judgment according to the patient's specific indicators, drug resistance, etc., and adjust to the optimal regimen.
Similar to changing ART regimens for other reasons, changing ART regimens due to dyslipidemia also needs to follow the principles of reducing adverse reactions, preventing drug interactions, improving compliance, and reducing medication burden.
Use of lipid-modifying drugs.
If the above two methods have not yet worked, the intervention of lipid-modifying drugs may be required. Lipid-modifying drugs that may be used include:
Statins.
Ezetimibe (cholesterol absorption inhibitor).
PCSK9 inhibitors.
Ethyl eicosapentaenoate (IPE, high-purity fish oil preparation).
The specific use should also be selected by a professional doctor according to the patient's condition.
Interpretation of lipid reports.
Therefore, for those who live with HIV, they usually come to our clinic for follow-up testingBe sure to remember to have your lipids checked regularlyOh, so that doctors can evaluate the long-term blood lipid change level of ** patients, control the risk in time, and reduce the incidence of cardiovascular disease.
References: 1] AIDS Group, Society of Tropical Diseases and Parasitology, Chinese Medical Association, Lu Hongzhou, Ma Ping. Human immunodeficiency virus (HIV) Chinese expert consensus on the comprehensive management of blood lipids in patients with acquired immunodeficiency syndrome. Chin J Internal Medicine,2023,62(6):661-672
2] jingjing lang, xin xin, panpan chen, zhen ning, and shaotan xiao.distinct patterns of fasting plasma glucose and lipid profile levels over time in adults tested positive for hiv on haart in shanghai, china, revealed using growth mixture models. front med (lausanne). 2022; 9: 1071431.
3] Joint Expert Committee on the Revision of Guidelines for the Management of Blood Lipids in China. Guidelines for the management of blood lipids in China (2023)[J].Chinese Journal of Cardiovascular Diseases, 2023, 51(3): 221-255doi: 10.3760/cma.j.cn112148‑20230119‑00038.