Implementation of Cholesterol-Lowering Therapy to Reduce Cardiovascular Risk in Persons Living with HIV
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REVIEW ARTICLE
Implementation of Cholesterol-Lowering Therapy to Reduce Cardiovascular Risk in Persons Living with HIV Stephani C. Wang 1 & Gurleen Kaur 2 & Joshua Schulman-Marcus 3 & Scott Purga 3 & Sulagna Mookherjee 3 & Cyndi Miller 4 & Mandeep S. Sidhu 3 & Robert S. Rosenson 5 Accepted: 17 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The widespread availability of highly effective antiretroviral therapies has reduced mortality from opportunistic infections in persons living with HIV (PLHIV), resulting in an increase in atherosclerotic cardiovascular disease (ASCVD) and other chronic illnesses (Samji et al. 2013). Although there has been a decline in morbidity and mortality from ASCVD in the past several decades, contemporary studies continue to report higher rates of cardiovascular events (Rosenson et al. 2020). HIV has been identified as a risk enhancer for ASCVD by multiple professional guideline writing committees (Grundy Scott et al. 2019, Mach et al. 2020); however, the utilization of cholesterol-lowering therapies in PLHIV remains low (Rosenson et al. 2018). Moreover, the use of statin therapy in PLHIV is complicated by drug-drug interactions that may either elevate or lower the blood statin concentrations resulting in increased toxicity or reduced efficacy respectively. Other comorbidities commonly associated with HIV present other challenges for the use of cholesterol-lowering therapies. This review will summarize the data on lipoproteinassociated ASCVD risk in PLHIV and discuss the challenges with effective treatment. Finally, we present a clinical algorithm to optimize cardiovascular risk reduction in this high-risk population. Keywords Dyslipidemia . Human immunodeficiency virus . Antiretroviral therapy . Cardiovascular disease
Atherosclerotic Cardiovascular Disease, Dyslipidemia, and HIV As antiretroviral therapies (ART) became more widely disseminated in the last few decades, it was observed that many treated patients with HIV were experiencing higher rates of Stephani C. Wang and Gurleen Kaur contributed equally to this work. * Mandeep S. Sidhu [email protected] 1
Division of Cardiology, Department of Medicine, University of California, Irvine, CA, USA
2
Albany Medical College, Albany, NY, USA
3
Division of Cardiology, Department of Medicine, Albany Medical College and Albany Medical Center, 47 New Scotland Avenue, Albany, NY, USA
4
Division of Infectious Disease, Department of Medicine, Albany Medical College and Albany Medical Center, Albany, NY, USA
5
Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
ASCVD, especially myocardial infarction (MI) [1–4]. Similarly, it was recognized that standard cardiovascular risk assessment tools such as the Framingham Risk Score frequently underestimated coronary artery disease burden in HIV patients [5, 6] and that prompted the development of alternate risk calculators [7, 8]. It has been challenging to disentangle whether the relative contributi
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