Cardiovascular risk and response to lipid lowering therapy in patients with HIV infection according to different recommendations

Optimizing statin therapy in HIV-infected patients: a review of pharmacotherapy considerations

BACKGROUND

People living with HIV (PLWH) are more vulnerable to cerebrovascular disease, including coronary artery disease. Dyslipidemia is a risk factor for major adverse cardiovascular events in this population as a whole. Dyslipidemia might result from general risk factors, HIV itself, or the adverse effects of the antiretroviral drug, which have different effects on lipid profile. The present study aims to review the latest studies regarding the role of statin initiation in this population and clinically significant drug interactions in the field.

METHODS

Databases, including Scopus, PubMed, Google Scholar, EMBASE, and Web of Science, were searched for relevant literature on the role of statins in primary/secondary prevention of CVD in PLWH based on the PICO search strategy. Moreover, ARTs-statin drug interactions were investigated and summarized based on the University of Liverpool's website.

RESULTS

Nearly 70 studies were found and summarized. Guidelines recommendations for using statins in PLWH and current practice, as well as the role and potential mechanism of statins in PLWH, were investigated. Based on the available data, we developed a practical algorithm that clinicians can use to optimize statin therapy in PLWH.

CONCLUSION

More studies are required to fully define the role of statins in HIV patients, including time to initiate and proper dosing. Moreover, a marked inconsistency exists between clinical guidelines and actual practice, mainly due to irrational concerns regarding antiretroviral-statin drug interactions.

High low-density lipoprotein cholesterol levels in people with HIV by individual cardiovascular risk: A retrospective observational study

BACKGROUND

People with HIV (PWH) are at increased risk of atherosclerotic cardiovascular disease (ASCVD). Lowering low-density lipoprotein cholesterol (LDL-C) is central of cardiovascular disease prevention. The aim of this study was to assess the prevalence, treatment, and control of high LDL-C levels as assessed on the basis of the ASCVD risk profiles indicated by European Society of Cardiology (ESC) guidelines of a cohort of PWH in order to evaluate the state of LDL-C management in current clinical practice.

METHODS

We retrospectively assessed the prevalence, treatment, and control of high LDL-C levels in a cohort of PWH aged ≥40 years who accessed our HIV outpatient clinic between 1 March 2022 and 31 March 2023. Their 10-year ASCVD risk was calculated on the basis of their age and co-morbidities as recommended by guidelines. High LDL-C levels were defined as those above the "step two" target of their specific ASCVD risk category.

RESULTS

Among the 1404 assessed PWH, who were prevalently male (74.5 %) and Caucasian (85.6 %), and had a median age of 56 years (interquartile range [IQR] 49-61), 295 (21 %) were at very high risk (VHR), 634 (45.2 %) at high-risk (HR), and 348 (24.8 %) not at HR. The overall median LDL-C level was 116 mg/dL (IQR 96-141). Five hundred and sixteen (37 %) were undergoing lipid lowering treatment (LLT), and 650 (46.3 %) failed to achieve any step of their target LDL-C levels.

CONCLUSIONS

Despite the high prevalence of PWH at VHR/HR for ASCVD, LDL-C levels were poorly controlled and LLT was greatly under used.

Pulmonary Embolism in a Young African American Male: A Diagnostic Challenge

This case report highlights the diagnostic challenges posed by pulmonary embolism (PE) in a young, otherwise healthy 33-year-old African American male with no apparent risk factors. The patient presented with penile pain, swelling, hematuria, flank pain, and rash, and was admitted for balanoposthitis and acute urinary retention. Despite prophylactic heparin, he suffered two cardiac arrests secondary to PE on the fifth day of hospitalization. Prompt thrombolytic therapy and heparin infusion were initiated, but his course was complicated by anuric acute kidney injury requiring hemodialysis, shock liver, and gastrointestinal bleeding. Imaging revealed a substantial thrombus burden in the pulmonary arteries. Notably, a hypercoagulable workup was negative. The absence of typical risk factors, negative hypercoagulable workup, and occurrence of PE despite prophylaxis underscore the importance of vigilance in recognizing atypical presentations. This case emphasizes the need for a high index of suspicion and comprehensive evaluation to diagnose PE in young patients without clear predisposing factors.

Atherosclerosis in HIV Patients: What Do We Know so Far?

For the past several decades, humanity has been dealing with HIV. This disease is one of the biggest global health problems. Fortunately, modern antiretroviral therapy allows patients to manage the disease, improving their quality of life and their life expectancy. In addition, the use of these drugs makes it possible to reduce the risk of transmission of the virus to almost zero. Atherosclerosis is another serious pathology that leads to severe health problems, including disability and, often, the death of the patient. An effective treatment for atherosclerosis has not yet been developed. Both types of immune response, innate and adaptive, are important components of the pathogenesis of this disease. In this regard, the peculiarities of the development of atherosclerosis in HIV carriers are of particular scientific interest. In this review, we have tried to summarize the data on atherosclerosis and its development in HIV carriers. We also looked at the classic therapeutic methods and their features concerning the concomitant diagnosis.

Correction: Cardiovascular risk and response to lipid lowering therapy in patients with HIV infection according to different recommendations

[This corrects the article DOI: 10.1371/journal.pone.0244675.].