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Contemporary protease inhibitors and cardiovascular risk

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Authors:
  • Lundgren, Jens ;
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    Infectious Diseases, Department of, Finsencentret, Rigshospitalet, The Capital Region of Denmark
  • Mocroft, Amanda ;
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    University College London
  • Ryom, Lene
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    Infectious Diseases, Department of, Finsencentret, Rigshospitalet, The Capital Region of Denmark
DOI:
10.1097/QCO.0000000000000425
Abstract:
PURPOSE OF REVIEW: To review the evidence linking use of HIV protease inhibitors with excess risk of cardiovascular disease (CVD) in HIV+ populations. RECENT FINDINGS: For the two contemporary most frequently used protease inhibitors, darunavir and atazanavir [both pharmacologically boosted with ritonavir (/r)], darunavir/r has been shown to be associated with increased CVD risk. The effect is cumulative with longer exposure increasing risk and an effect size comparable to what has been observed for previously developed protease inhibitors. Biological mechanisms may be overlapping and include perturbed lipid metabolism and accumulation of cholesterol derivatives within macrophages. Conversely, atazanavir/r has not been shown to be associated with CVD, possibly because of its ability to increase cardioprotective bilirubin levels. SUMMARY: Evidence linking protease inhibitors to CVD is based on observational studies only, whereas plausible biological explanations are well established and derived from randomized trials and controlled experiments. Given the possible association with clinical disease, a conservative approach to apply the data in daily practise is proposed which is focused on individualization of care based on underlying risk of CVD.
Type:
Journal article
Language:
English
Published in:
Current Opinion in Infectious Diseases, 2018, Vol 31, Issue 1, p. 8-13
Keywords:
Journal Article; Research Support, Non-U.S. Gov't
Main Research Area:
Medical science
Publication Status:
Published
Review type:
Peer Review
Submission year:
2018
Scientific Level:
Scientific
ID:
2394145901

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