CMEonHIV.com is dedicated to providing online CME presentations (slides with voiceover) on HIV/AIDS for healthcare professionals given by local and international experts to keep you up-to-date on the ongoing developments in the field.
Conference
"Dyslipidemias and Highly Active Anti-viral Therapy (HAART)" Dr. Greg Bondy (biography) English - 2003-03-30 - 32 minutes
Summary : Advances in anti-viral therapy have revolutionized the treatment of patients with HIV. These patients have a much greater life expectancy with a good quality of life. Unexpectedly, highly active anti-viral therapy (HAART) has induced a number of metabolic problems and this side effect of HIV therapy has been called the HIV metabloc syndrome. This syndrome is characterized by alterations in body fat distribution, dyslidipidemias, insulin resitance and most recently accelerated bone loss. Features of the dyslipidemia seen in this syndrome include severe hypertriglyceridemia, low HDL cholesterol and an elevation in the LDL cholesterol. This dyslipidemia pattern is extremely atherogenic and coupled with other factors present in HIV patients such as insulin resitance and vascular inflammation places these patients at increased risk for developing premature cardiovascular disease. Re-assuredly, the Veterans Affair HIV study (NEJM 348:702, 2003) showed that HAART therapy did not lead to increased rates of cardiovascular disease. This study is limited by the short mean duration of exposure of patients to HAART and the relatively young age of the cohort studied (< 10% greater than age 55). It remains to be determined if long-term treatment with HAART will lead to increase rates of vascular disease.
This presentation will review the assessment and treatment of the dyslipidemias associated with HAART therapy. Cardiovascular risk assessment included the use of traditional risk factors in Framingham tables and the utility of surrogate markers of cardiovascular disease such as apo B, C-reactive protein and B-mode carotid ultrasound. Treatment paradigms used at the St. Paul`s IDC HIV metabolic clinic were outlined and included ongoing studies examining the effectiveness of dietary and pharmacological treatment of patients with the HIV metabolic syndrome.
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